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Spine
Diagnosis
Congenital
Normal Anatomical Variations
Conjoined Nerve Roots
Conjoined Nerve Roots
Kevin R. Moore, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Conjoined nerve root (CNR)

              • Synonyms

                • Composite nerve root sleeve

              • Definitions

                • Asymmetric anomalous origin of enlarged nerve root sleeve containing 2 nerve roots

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Ultrasonographic Findings

                        • Nonvascular Interventions

                          • Imaging Recommendations

                            DIFFERENTIAL DIAGNOSIS

                              PATHOLOGY

                              • General Features

                                • Gross Pathologic & Surgical Features

                                  • Microscopic Features

                                    CLINICAL ISSUES

                                    • Presentation

                                      • Demographics

                                        • Natural History & Prognosis

                                          • Treatment

                                            DIAGNOSTIC CHECKLIST

                                            • Consider

                                              • Image Interpretation Pearls

                                                Selected References

                                                1. Can H et al: Lumbosacral conjoined root anomaly: anatomical considerations of exiting angles and root thickness. Turk Neurosurg. 27(4):617-22, 2017
                                                2. Harsha KJ et al: Positive straight leg raising test secondary to conjoined lumbosacral nerve roots. Neurology. 85(21):1913, 2015
                                                3. Engar C et al: Conjoined lumbosacral nerve roots: direct demonstration on MR neurography. Clin Imaging. 38(6):892-4, 2014
                                                4. Popa I et al: Intraoperative conjoined lumbosacral nerve roots associated with spondylolisthesis. Eur J Orthop Surg Traumatol. 23 Suppl 1:S115-9, 2013
                                                5. Trimba R et al: Conjoined nerve roots of the lumbar spine. Spine J. 12(6):515-24, 2012
                                                6. Taghipour M et al: Conjoined lumbosacral nerve roots: analysis of cases diagnosed intraoperatively. J Spinal Disord Tech. 22(6):413-6, 2009
                                                7. Song SJ et al: Imaging features suggestive of a conjoined nerve root on routine axial MRI. Skeletal Radiol. 37(2):133-8, 2008
                                                8. Artico M et al: Conjoined lumbosacral nerve roots: observations on three cases and review of the literature. Neurocirugia (Astur). 17(1):54-9, 2006
                                                9. Scuderi GJ et al: Conjoined lumbar nerve roots: a frequently underappreciated congenital abnormality. J Spinal Disord Tech. 17(2):86-93, 2004
                                                10. Bottcher J et al: Conjoined lumbosacral nerve roots: current aspects of diagnosis. Eur Spine J, 2003
                                                11. Haijiao W et al: Diagnosis of lumbosacral nerve root anomalies by magnetic resonance imaging. J Spinal Disord. 14(2):143-9, 2001
                                                12. Savas R et al: Hypoplastic lumbar pedicle in association with conjoined nerve root MRI demonstration. Comput Med Imaging Graph. 22(1):77-9, 1998
                                                13. Sener RN: Sacral pedicle agenesis. Comput Med Imaging Graph. 21(6):361-3, 1997
                                                14. Prestar FJ: Anomalies and malformations of lumbar spinal nerve roots. Minim Invasive Neurosurg. 39(4):133-7, 1996
                                                15. Chu CR et al: Cervical conjoined nerve root variant: preoperative imaging and surgical conformation. Case report. J Neurosurg. 80(3):548-51, 1994
                                                16. Firooznia H et al: Normal correlative anatomy of the lumbosacral spine and its contents. Neuroimaging clinics of North America 3(3): 411-24, 1993
                                                17. Gomez JG et al: Conjoined lumbosacral nerve roots. Acta Neurochir (Wien). 120(3-4):155-8, 1993
                                                18. Phillips LH 2nd et al: The frequency of intradural conjoined lumbosacral dorsal nerve roots found during selective dorsal rhizotomy. Neurosurgery. 33(1):88-90; discussion 90-1, 1993
                                                19. Okuwaki T et al: Conjoined nerve roots associated with lumbosacral spine anomalies. A case report. Spine. 16(11):1347-9, 1991
                                                20. Maiuri F et al: Anomalies of the lumbosacral nerve roots. Neurol Res. 11(3):130-5, 1989
                                                21. Goffin J et al: Association of conjoined and anastomosed nerve roots in the lumbar region. A case report. Clin Neurol Neurosurg. 89(2):117-20, 1987
                                                22. Torricelli P et al: CT diagnosis of lumbosacral conjoined nerve roots. Findings in 19 cases. Neuroradiology. 29(4):374-9, 1987
                                                23. Hoddick WK et al: Bony spinal canal changes that differentiate conjoined nerve roots from herniated nucleus pulposus. Radiology. 154(1):119-20, 1985
                                                24. Peyster RG et al: Computed tomography of lumbosacral conjoined nerve root anomalies. Potential cause of false-positive reading for herniated nucleus pulposus. Spine. 10(4):331-7, 1985
                                                25. Gebarski SS et al: "Conjoined" nerve roots: a requirement for computed tomographic and myelographic correlation for diagnosis. Neurosurgery. 14(1):66-8, 1984
                                                26. Rosner MJ et al: Anomalous exit of the C-6 nerve root via the C-6, C-7 foramen. Neurosurgery. 14(6):740-3, 1984
                                                27. Cail WS et al: Conjoined lumbosacral nerve roots. Diagnosis with metrizamide myelography. Surg Neurol. 20(2):113-9, 1983
                                                28. Coughlin JR et al: Metrizamide myelography in conjoined lumbosacral nerve roots. J Can Assoc Radiol. 34(1):23-5, 1983
                                                29. Neidre A et al: Anomalies of the lumbosacral nerve roots. Review of 16 cases and classification. Spine. 8(3):294-9, 1983
                                                30. Helms CA et al: The CT appearance of conjoined nerve roots and differentiation from a herniated nucleus pulposus. Radiology. 144(4):803-7, 1982
                                                31. White JG 3rd et al: Surgical treatment of 63 cases of conjoined nerve roots. J Neurosurg. 56(1):114-7, 1982
                                                32. Epstein JA et al: Conjoined lumbosacral nerve roots. Management of herniated discs and lateral recess stenosis in patients with this anomaly. J Neurosurg. 55(4):585-9, 1981
                                                33. Bouchard JM et al: Preoperative diagnosis of conjoined roots anomaly with herniated lumbar disks. Surg Neurol. 10(4):229-31, 1978
                                                Related Anatomy
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                                                Related Differential Diagnoses
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                                                References
                                                Tables

                                                Tables

                                                KEY FACTS

                                                • Terminology

                                                  • Imaging

                                                    • Top Differential Diagnoses

                                                      • Pathology

                                                        • Clinical Issues

                                                          • Diagnostic Checklist

                                                            TERMINOLOGY

                                                            • Abbreviations

                                                              • Conjoined nerve root (CNR)

                                                            • Synonyms

                                                              • Composite nerve root sleeve

                                                            • Definitions

                                                              • Asymmetric anomalous origin of enlarged nerve root sleeve containing 2 nerve roots

                                                            IMAGING

                                                            • General Features

                                                              • Radiographic Findings

                                                                • CT Findings

                                                                  • MR Findings

                                                                    • Ultrasonographic Findings

                                                                      • Nonvascular Interventions

                                                                        • Imaging Recommendations

                                                                          DIFFERENTIAL DIAGNOSIS

                                                                            PATHOLOGY

                                                                            • General Features

                                                                              • Gross Pathologic & Surgical Features

                                                                                • Microscopic Features

                                                                                  CLINICAL ISSUES

                                                                                  • Presentation

                                                                                    • Demographics

                                                                                      • Natural History & Prognosis

                                                                                        • Treatment

                                                                                          DIAGNOSTIC CHECKLIST

                                                                                          • Consider

                                                                                            • Image Interpretation Pearls

                                                                                              Selected References

                                                                                              1. Can H et al: Lumbosacral conjoined root anomaly: anatomical considerations of exiting angles and root thickness. Turk Neurosurg. 27(4):617-22, 2017
                                                                                              2. Harsha KJ et al: Positive straight leg raising test secondary to conjoined lumbosacral nerve roots. Neurology. 85(21):1913, 2015
                                                                                              3. Engar C et al: Conjoined lumbosacral nerve roots: direct demonstration on MR neurography. Clin Imaging. 38(6):892-4, 2014
                                                                                              4. Popa I et al: Intraoperative conjoined lumbosacral nerve roots associated with spondylolisthesis. Eur J Orthop Surg Traumatol. 23 Suppl 1:S115-9, 2013
                                                                                              5. Trimba R et al: Conjoined nerve roots of the lumbar spine. Spine J. 12(6):515-24, 2012
                                                                                              6. Taghipour M et al: Conjoined lumbosacral nerve roots: analysis of cases diagnosed intraoperatively. J Spinal Disord Tech. 22(6):413-6, 2009
                                                                                              7. Song SJ et al: Imaging features suggestive of a conjoined nerve root on routine axial MRI. Skeletal Radiol. 37(2):133-8, 2008
                                                                                              8. Artico M et al: Conjoined lumbosacral nerve roots: observations on three cases and review of the literature. Neurocirugia (Astur). 17(1):54-9, 2006
                                                                                              9. Scuderi GJ et al: Conjoined lumbar nerve roots: a frequently underappreciated congenital abnormality. J Spinal Disord Tech. 17(2):86-93, 2004
                                                                                              10. Bottcher J et al: Conjoined lumbosacral nerve roots: current aspects of diagnosis. Eur Spine J, 2003
                                                                                              11. Haijiao W et al: Diagnosis of lumbosacral nerve root anomalies by magnetic resonance imaging. J Spinal Disord. 14(2):143-9, 2001
                                                                                              12. Savas R et al: Hypoplastic lumbar pedicle in association with conjoined nerve root MRI demonstration. Comput Med Imaging Graph. 22(1):77-9, 1998
                                                                                              13. Sener RN: Sacral pedicle agenesis. Comput Med Imaging Graph. 21(6):361-3, 1997
                                                                                              14. Prestar FJ: Anomalies and malformations of lumbar spinal nerve roots. Minim Invasive Neurosurg. 39(4):133-7, 1996
                                                                                              15. Chu CR et al: Cervical conjoined nerve root variant: preoperative imaging and surgical conformation. Case report. J Neurosurg. 80(3):548-51, 1994
                                                                                              16. Firooznia H et al: Normal correlative anatomy of the lumbosacral spine and its contents. Neuroimaging clinics of North America 3(3): 411-24, 1993
                                                                                              17. Gomez JG et al: Conjoined lumbosacral nerve roots. Acta Neurochir (Wien). 120(3-4):155-8, 1993
                                                                                              18. Phillips LH 2nd et al: The frequency of intradural conjoined lumbosacral dorsal nerve roots found during selective dorsal rhizotomy. Neurosurgery. 33(1):88-90; discussion 90-1, 1993
                                                                                              19. Okuwaki T et al: Conjoined nerve roots associated with lumbosacral spine anomalies. A case report. Spine. 16(11):1347-9, 1991
                                                                                              20. Maiuri F et al: Anomalies of the lumbosacral nerve roots. Neurol Res. 11(3):130-5, 1989
                                                                                              21. Goffin J et al: Association of conjoined and anastomosed nerve roots in the lumbar region. A case report. Clin Neurol Neurosurg. 89(2):117-20, 1987
                                                                                              22. Torricelli P et al: CT diagnosis of lumbosacral conjoined nerve roots. Findings in 19 cases. Neuroradiology. 29(4):374-9, 1987
                                                                                              23. Hoddick WK et al: Bony spinal canal changes that differentiate conjoined nerve roots from herniated nucleus pulposus. Radiology. 154(1):119-20, 1985
                                                                                              24. Peyster RG et al: Computed tomography of lumbosacral conjoined nerve root anomalies. Potential cause of false-positive reading for herniated nucleus pulposus. Spine. 10(4):331-7, 1985
                                                                                              25. Gebarski SS et al: "Conjoined" nerve roots: a requirement for computed tomographic and myelographic correlation for diagnosis. Neurosurgery. 14(1):66-8, 1984
                                                                                              26. Rosner MJ et al: Anomalous exit of the C-6 nerve root via the C-6, C-7 foramen. Neurosurgery. 14(6):740-3, 1984
                                                                                              27. Cail WS et al: Conjoined lumbosacral nerve roots. Diagnosis with metrizamide myelography. Surg Neurol. 20(2):113-9, 1983
                                                                                              28. Coughlin JR et al: Metrizamide myelography in conjoined lumbosacral nerve roots. J Can Assoc Radiol. 34(1):23-5, 1983
                                                                                              29. Neidre A et al: Anomalies of the lumbosacral nerve roots. Review of 16 cases and classification. Spine. 8(3):294-9, 1983
                                                                                              30. Helms CA et al: The CT appearance of conjoined nerve roots and differentiation from a herniated nucleus pulposus. Radiology. 144(4):803-7, 1982
                                                                                              31. White JG 3rd et al: Surgical treatment of 63 cases of conjoined nerve roots. J Neurosurg. 56(1):114-7, 1982
                                                                                              32. Epstein JA et al: Conjoined lumbosacral nerve roots. Management of herniated discs and lateral recess stenosis in patients with this anomaly. J Neurosurg. 55(4):585-9, 1981
                                                                                              33. Bouchard JM et al: Preoperative diagnosis of conjoined roots anomaly with herniated lumbar disks. Surg Neurol. 10(4):229-31, 1978