Conjoined nerve root, epidural varicose vein, and extruded lumbar disc: Triad of refractory sciatica.

BACKGROUND

A patient presented with sciatica attributed to a conjoined lumbosacral nerve root, an extruded disc herniation, and epidural varicose veins.

CASE DESCRIPTION: A 60-year-old male presented with 5 months of sciatica (4/5 motor deficit). The lumbosacral magnetic resonance showed a right paracentral disc herniation causing thecal sac/L5-S1 nerve root compression. Intraoperatively, the patient had an L5-S1 conjoined nerve root, an extruded disc herniation, and type C epidural varicose veins. A wide fenestration and foraminotomy were performed to facilitate the removal of the extruded disc and partial coagulation of the epidural varicose veins. Surgery resulted in complete symptom resolution within the 1st postoperative month.

CONCLUSION

A patient with intractable right-sided sciatic was found at surgery to have an L5-S1 conjoined nerve root, a herniated disc, and marked epidural varicosities. Following a wide fenestration/foraminal decompression, the patient's symptoms fully resolved within the 1st postoperative month.