Unexpected Right-Sided Nerve Root Variant During L4-L5 Microdiscectomy and Decompression: A Case Report Highlighting Diagnostic and Intraoperative Challenges.
Abukar Abdi Nor, Abdiweli Mohamed Abdi, Nur Abdullahi Karshe et al.
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Case in brief
A 45-year-old woman presented with predominantly right-sided leg numbness and paresthesia, radiating pain, and preserved strength. MRI showed an L4–L5 disc bulge, bilateral L5 root abutment, and mild foraminal narrowing, without a reported root anomaly. At microdiscectomy and decompression, surgeons unexpectedly found two right-sided neural structures, suspected to represent a duplicated exiting L4 root, and preserved both. Retrospective MRI review did not confirm the variant, and electrophysiological identification was not feasible. Over five months of telephone follow-up, she reported improvement in pain, walking tolerance, and sensory symptoms, with no reported neurological deterioration; objective follow-up assessment was unavailable.
What made this case unusual
Two right-sided neural structures were encountered intraoperatively despite no anomaly being reported on preoperative MRI; retrospective review also did not confirm the suspected L4 root duplication, leaving its anatomical classification uncertain.
Diagnostic / clinical pearl
When operative neural anatomy does not match preoperative imaging, carefully identify and preserve unexpected structures; in this case, the suspected root variant could not be definitively classified.