Conjoined nerve root L5-S1 with hemilumbarisation S1

Case contributed by Dr Tim Luijkx

Presentation

Bilateral lower back and right groin pain. Compression L1?

Patient Data

Age: 40 years
Gender: Female

Previous abdominal X-ray for different reasons

Modality: X-ray

Vertebral body S1 is lumbarised. This is complete on the left side and partial on the right side, where there is an articulation between S1 and the remainder of the sacrum. Also note that there are five vertebrae above it that have no ribs, indicating that they are of lumbar nature.

The vertebra appearing as L5 is actually a hemilumbalired S1 vertebra.
There is an empty neuroforamen on the level of S1-S2 on the right side. The S1 nerve root exits one level higher together with the L5 nerve root as can be seen both on sagittal and transverse images.

Case Discussion

Beware of conjoined nerve roots and variant anatomy of the lumbosacral spine. In this case the x-ray nicely shows that S1 is lumbarised completely on the left side and partially on the right side. This can trick you into miscounting the exiting nerve roots.

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Case Information

rID: 51897
Case created: 12th Mar 2017
Last edited: 12th Mar 2017
Inclusion in quiz mode: Included

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