{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T12:32:52Z","timestamp":1777465972743,"version":"3.51.4"},"reference-count":22,"publisher":"SAGE Publications","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMR"],"published-print":{"date-parts":[[2022,9,2]]},"abstract":"<jats:p>BACKGROUND: Spinal nerve root anomaly is a rare feature that can result in unexpected outcomes in epidural steroid injections or surgical procedures. Preoperative diagnostic tools for root anomalies are limited, as they are usually found intraoperatively. OBJECTIVE: This case report aims to propose an effective diagnostic process for nerve root anomalies by introducing clinical manifestations, electrodiagnostic findings, and sophisticated imaging techniques such as coronal view magnetic resonance imaging (MRI) of the lumbosacral spine. CASE DESCRIPTION: A 43-year-old female complained of low back pain with radicular pain to the lower extremities. Based on physical examination, electrodiagnosis, and imaging studies, right L5 radiculopathy was diagnosed. Repetitive image-guided epidural steroid injections presented unsuccessful outcomes. She was then referred to a neurosurgeon for surgical decompression, which resulted in significant improvement in her radicular pain. A nerve root anomaly was found intraoperatively, and the coronal images of postoperative MRI depicted the conjoined nerve root of the lumbar spine. CONCLUSION: When proper image-guided spinal interventions for discogenic radicular pain are not effective, a clinician should be advised to consider the possibility of anatomical variation, including nerve root anomalies. Early diagnosis of nerve root anomalies by utilizing multiple diagnostic tools, especially coronal MRI, can aid in preoperative diagnosis and proper clinical decisions for symptom management.<\/jats:p>","DOI":"10.3233\/bmr-210226","type":"journal-article","created":{"date-parts":[[2022,5,10]],"date-time":"2022-05-10T12:13:05Z","timestamp":1652184785000},"page":"971-976","source":"Crossref","is-referenced-by-count":1,"title":["Nerve root anomaly as a cause of unexpected outcomes of epidural steroid injections in lumbar radiculopathy: A case report"],"prefix":"10.1177","volume":"35","author":[{"given":"Dong Jae","family":"Shin","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yeon Soo","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Radiology, Daejeon St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eunseok","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Daejeon St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jin-Seok","family":"Yi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Daejeon St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","reference":[{"issue":"6","key":"10.3233\/BMR-210226_ref1","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1016\/j.spinee.2012.06.004","article-title":"Conjoined nerve roots of the lumbar spine","volume":"12","author":"Trimba","year":"2012","journal-title":"Spine J."},{"issue":"3","key":"10.3233\/BMR-210226_ref2","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1007\/s00256-007-0421-4","article-title":"Conjoined lumbosacral nerve roots compromised by disk herniation: Sagittal shoulder sign for the preoperative diagnosis","volume":"37","author":"Kang","year":"2008","journal-title":"Skeletal Radiol."},{"issue":"5","key":"10.3233\/BMR-210226_ref3","doi-asserted-by":"crossref","first-page":"721","DOI":"10.2106\/00004623-198264050-00009","article-title":"Lumbosacral nerve-root anomalies","volume":"64","author":"Postacchini","year":"1982","journal-title":"J Bone Joint Surg Am."},{"issue":"12","key":"10.3233\/BMR-210226_ref4","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1007\/s00276-017-1903-2","article-title":"Intraspinal intradural variations of nerve roots","volume":"39","author":"Matej\u010d\u00edk","year":"2017","journal-title":"Surg Radiol Anat."},{"issue":"1","key":"10.3233\/BMR-210226_ref5","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/S1130-1473(06)70370-0","article-title":"Conjoined lumbosacral nerve roots observations on three cases and review of the literature","volume":"17","author":"Artico SF","year":"2006","journal-title":"Neurocirug\u00eda."},{"issue":"1","key":"10.3233\/BMR-210226_ref6","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1177\/230949901202000118","article-title":"Intra-operative identification of conjoined lumbosacral nerve roots: A report of three cases","volume":"20","author":"Morishita","year":"2012","journal-title":"J Orthop Surg (Hong Kong)."},{"issue":"2","key":"10.3233\/BMR-210226_ref7","doi-asserted-by":"crossref","first-page":"E9","DOI":"10.3171\/2013.2.FOCUS1349","article-title":"Nerve root anomalies: Implications for transforaminal lumbar interbody fusion surgery and a review of the Neidre and Macnab classification system","volume":"35","author":"Burke","year":"2013","journal-title":"Neurosurg Focus."},{"issue":"4","key":"10.3233\/BMR-210226_ref8","first-page":"14","article-title":"Conjoint Lumbosacral Nerve Root-A Case Report","volume":"5","author":"Jokhi","year":"2015","journal-title":"J Orthop Case Rep."},{"key":"10.3233\/BMR-210226_ref9","doi-asserted-by":"crossref","first-page":"2851","DOI":"10.2147\/JPR.S327504","article-title":"Electromyography and Therapeutic Response to Lumbosacral Epidural Steroid Injections: A Systematic Review","volume":"14","author":"Meiling","year":"2021","journal-title":"J Pain Res."},{"issue":"1","key":"10.3233\/BMR-210226_ref10","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.jpain.2007.08.011","article-title":"The use of electromyography to predict functional outcome following transforaminal epidural spinal injections for lumbar radiculopathy","volume":"9","author":"Fish","year":"2008","journal-title":"J Pain."},{"issue":"4","key":"10.3233\/BMR-210226_ref11","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1007\/s00586-018-05867-1","article-title":"Identification of abnormalities in the lumbar nerve tract using diffusion-weighted magnetic resonance neurography","volume":"28","author":"Manabe","year":"2019","journal-title":"Eur Spine J."},{"issue":"2","key":"10.3233\/BMR-210226_ref12","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1097\/00002517-199704000-00010","article-title":"Presurgical identification of extradural nerve root anomalies by coronal fat-suppressed magnetic resonance imaging: A report of six cases and a review of the literature","volume":"10","author":"Aota","year":"1997","journal-title":"J Spinal Disord."},{"issue":"8","key":"10.3233\/BMR-210226_ref13","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1007\/s00381-017-3457-3","article-title":"Nerve root anomalies: Making sense of a complicated literature","volume":"33","author":"Schmidt","year":"2017","journal-title":"Childs Nerv Syst."},{"issue":"4","key":"10.3233\/BMR-210226_ref14","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1055\/s-2008-1052233","article-title":"Anomalies and malformations of lumbar spinal nerve roots","volume":"39","author":"Prestar","year":"1996","journal-title":"Minim Invasive Neurosurg."},{"issue":"7","key":"10.3233\/BMR-210226_ref15","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1007\/s00586-010-1329-6","article-title":"Clinical features of conjoined lumbosacral nerve roots versus lumbar intervertebral disc herniations","volume":"19","author":"Lotan","year":"2010","journal-title":"Eur Spine J."},{"issue":"3","key":"10.3233\/BMR-210226_ref16","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1097\/00007632-198304000-00010","article-title":"Anomalies of the lumbosacral nerve roots. Review of 16 cases and classification","volume":"8","author":"Neidre","year":"1983","journal-title":"Spine (Phila Pa 1976)."},{"issue":"9","key":"10.3233\/BMR-210226_ref17","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1097\/00007632-199605010-00001","article-title":"Morphometric analysis of the lumbosacral nerve roots and dorsal root ganglia by magnetic resonance imaging","volume":"21","author":"Hasegawa","year":"1996","journal-title":"Spine (Phila Pa 1976)."},{"issue":"2","key":"10.3233\/BMR-210226_ref18","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1007\/s00590-017-2026-5","article-title":"Morphological anatomy of thoracolumbar nerve roots and dorsal root ganglia","volume":"28","author":"Leng","year":"2018","journal-title":"Eur J Orthop Surg Traumatol."},{"issue":"2","key":"10.3233\/BMR-210226_ref19","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1002\/mus.21759","article-title":"Utility of electrodiagnostic testing in evaluating patients with lumbosacral radiculopathy: An evidence-based review","volume":"42","author":"Cho","year":"2010","journal-title":"Muscle Nerve."},{"issue":"2","key":"10.3233\/BMR-210226_ref20","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/j.ncl.2007.01.008","article-title":"Lumbosacral radiculopathy","volume":"25","author":"Tarulli","year":"2007","journal-title":"Neurol Clin."},{"issue":"2","key":"10.3233\/BMR-210226_ref21","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1007\/s00586-007-0529-1","article-title":"Polysegmental innervation of the medial paraspinal lumbar muscles","volume":"17","author":"Kottlors","year":"2008","journal-title":"Eur Spine J."},{"issue":"3","key":"10.3233\/BMR-210226_ref22","doi-asserted-by":"crossref","first-page":"423","DOI":"10.4184\/asj.2018.12.3.423","article-title":"Usefulness of Oblique Lumbar Magnetic Resonance Imaging for Nerve Root Anomalies and Extraforaminal Entrapment Lesions","volume":"12","author":"Heo","year":"2018","journal-title":"Asian Spine J."}],"container-title":["Journal of Back and Musculoskeletal Rehabilitation"],"original-title":[],"link":[{"URL":"https:\/\/content.iospress.com\/download?id=10.3233\/BMR-210226","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T13:27:04Z","timestamp":1777382824000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/full\/10.3233\/BMR-210226"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,2]]},"references-count":22,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3233\/bmr-210226","relation":{},"ISSN":["1878-6324","1053-8127"],"issn-type":[{"value":"1878-6324","type":"electronic"},{"value":"1053-8127","type":"print"}],"subject":[],"published":{"date-parts":[[2022,9,2]]}}}