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 proposean 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.

中文翻译：

---

神经根异常是腰椎神经根病硬膜外类固醇注射意外结果的原因：病例报告

背景：脊髓神经根异常是一种罕见的特征，在硬膜外类固醇注射或外科手术中会导致意想不到的结果。根部异常的术前诊断工具是有限的，因为它们通常在术中发现。目的：本病例报告旨在通过介绍临床表现、电诊断结果和复杂的成像技术，如腰骶椎冠状位磁共振成像 (MRI)，提出一种有效的神经根异常诊断方法。病例描述：一名 43 岁的女性主诉腰痛并伴有下肢神经根性疼痛。根据体格检查、电诊断和影像学检查，诊断为右侧 L5 神经根病。重复图像引导的硬膜外类固醇注射呈现不成功的结果。然后她被转诊到神经外科医生处进行手术减压，这导致她的神经根疼痛得到显着改善。术中发现神经根异常，术后MRI冠状位图像显示腰椎联合神经根。结论：当适当的影像引导脊柱干预对椎间盘源性神经根痛无效时，应建议临床医生考虑解剖变异的可能性，包括神经根异常。通过利用多种诊断工具，尤其是冠状 MRI，对神经根异常进行早期诊断，有助于术前诊断和症状管理的正确临床决策。术中发现神经根异常，术后MRI冠状位图像显示腰椎联合神经根。结论：当适当的影像引导脊柱干预对椎间盘源性神经根痛无效时，应建议临床医生考虑解剖变异的可能性，包括神经根异常。通过利用多种诊断工具，尤其是冠状 MRI，对神经根异常进行早期诊断，有助于术前诊断和症状管理的正确临床决策。术中发现神经根异常，术后MRI冠状位图像显示腰椎联合神经根。结论：当适当的影像引导脊柱干预对椎间盘源性神经根痛无效时，应建议临床医生考虑解剖变异的可能性，包括神经根异常。通过利用多种诊断工具，尤其是冠状 MRI，对神经根异常进行早期诊断，有助于术前诊断和症状管理的正确临床决策。包括神经根异常。通过利用多种诊断工具，尤其是冠状 MRI，对神经根异常进行早期诊断，有助于术前诊断和症状管理的正确临床决策。包括神经根异常。通过利用多种诊断工具，尤其是冠状 MRI，对神经根异常进行早期诊断，有助于术前诊断和症状管理的正确临床决策。