Contralateral discectomy as a novel approach for disc herniation compressing a conjoined nerve root: illustrative case

BACKGROUND A conjoined nerve root is a rare condition with numerous variants. The diagnosis can be challenging, especially when the condition coexists with other pathologies. In cases where a disc herniation affects these nerve roots, any miscalculation or inexperience of the surgeon can irreversibly injure them. Numerous reports have described the dismay of surgeons during discectomy in patients with a conjoined nerve root. Many surgical techniques have been suggested but without the good results following typical discectomies. OBSERVATIONS In this case report, the authors describe a 53-year-old female patient who presented with radicular pain due to a large disc herniation at the level of L5–S1 on the left side. Intraoperatively, the authors identified a conjoined nerve root, forcing them to employ a novel approach with very good results. LESSONS In some cases, the only possible way to remove a disc herniation is the contralateral approach, as described in this report. https://thejns.org/doi/10.3171/CASE24301