Conjoined nerve root, epidural varicose vein, and extruded lumbar disc: Triad of refractory sciatica.

Background: A patient presented with sciatica attributed to a conjoined lumbosacral nerve root, an extruded disc herniation, and epidural varicose veins.

Case description: A 60-year-old male presented with 5 months of sciatica (4/5 motor deficit). The lumbosacral magnetic resonance showed a right paracentral disc herniation causing thecal sac/L5-S1 nerve root compression. Intraoperatively, the patient had an L5-S1 conjoined nerve root, an extruded disc herniation, and type C epidural varicose veins. A wide fenestration and foraminotomy were performed to facilitate the removal of the extruded disc and partial coagulation of the epidural varicose veins. Surgery resulted in complete symptom resolution within the 1^st postoperative month.

Conclusion: A patient with intractable right-sided sciatic was found at surgery to have an L5-S1 conjoined nerve root, a herniated disc, and marked epidural varicosities. Following a wide fenestration/foraminal decompression, the patient's symptoms fully resolved within the 1^st postoperative month.