2018 Volume 27 Issue 9 Pages 679-685
Typical neurological symptoms of lumbar disc hernia (LDH) are determined by the level of the lesion. However, a discrepancy between symptoms and morbidity exists in patients with nerve root anomaly (NRA), which is not a rare condition. Here we present the case of a patient with LDH and NRA as well as the observations during diagnosis and surgery. The patient was a 67-year-old male with left leg pain. LDH in the left L4/5 was diagnosed, and he was conservatively treated in another hospital. Recurrence of lumbar pain and leg pain occurred after 7 months. His symptoms involved pain from the gluteal area to the posterior thigh and posterior and lateral lower leg and sole ; these are atypical of L4/5 disc hernia. Therefore, coexistence of L3/4 disc hernia was considered. He was transferred to our hospital for surgery. Magnetic resonance imaging (MRI) revealed a caudally migrated disc fragment compressing nerve roots at the L4/5 level. One of the roots was followed caudally on continuous axial MRI images, and it was found to be an S1 root. A type 2a NRA per the Kadish classification, with a cranial origin of the nerve root, was diagnosed. The disc hernia was planned to be surgically removed between the L5 and S1 root via left L4/5 hemilaminectomy. The possibility of excess bleeding from L5 root axilla and dural tears were points of concern. The surgical procedure was performed meticulously, and disc hernia was removed as planned. The patient’s symptoms improved immediately. To the best of our knowledge, this is the first case report of surgical therapy for LDH of type 2a per Kadish classification. Surgery in patients with LDH and NRA requires special care, and preoperative diagnosis is also important.
