Technical Considerations in Uniportal Endoscopic Decompression of Conjoined Lumbar Nerve Roots

Objectives: Conjoined nerve roots (CNRs) represent a common yet frequently underdiagnosed congenital anomaly of the lumbar spine that increases the risk of iatrogenic injury. The objectives are to define, identify, and decompress incidentally detected CNRs. Materials and Methods: A 35-year-old male presented with low back pain and right leg radiating pain due to a lumbar disc herniation at the right L5–S1. On MRI lumbosacral region, there was no abnormal findings or signs, and he was posted for full endoscopic (uniportal) discectomy. While defining traversing root, there was another root joined to the shoulder of the traversing root. With the help of angled vision other root (conjoined) was delineated and decompressed safely. Disc fragments (discectomy) were removed through the “Axillary approach” and both the conjoined nerve roots were decompressed without putting traction on any of the nerves. Results: The patient was pain-free immediately in the postoperative period there was no sensory deficit. His visual analog scale (VAS) score improved from 7 to 3, and the Oswestry Disability Index (ODI) improved from 46 to 16. He had regular follow-ups in the first month, third month, and on sixth month with no fresh complaints. He was asymptomatic throughout. Conclusion: Full endoscopic monoportal/uniportal technique provides angled vision for precise identification and safe decompression of unexpected CNRs, serving as both a diagnostic and therapeutic modality.