Forty-six cases of anomalous lumbosacral nerve roots were found in a
series of 2123 patients who underwent myelography with water-soluble
contrast medium. The anomalies were classified into five types. In Types I
and II, one or more nerve roots emerged from the theca at a more cranial
(Type I) or caudal (Type II) level than normal. In Type III, two or more
roots emerged through closely adjacent openings in the dura, whereas in
Type IV two nerve roots emerged from the dural sac combined as one nerve
trunk. In Type V, two roots were connected by an anastomotic branch shortly
after their emergence from the dura. The anomalies were usually unilateral
and the fifth lumbar and first sacral-nerve roots were the most frequently
involved. Type-III and Type-IV anomalies were the most common (69 per
cent). Twenty-one per cent of the patients had lumbosacral anomalies and
one had congenital absence of the articular facets of the lumbosacral joint
on the side of the nerve-root anomaly. In seven patients the anomalous root
or roots were compressed by a herniated disc, and the roots were entrapped
in a lateral recess or intervertebral foramen in two. Symptoms and signs of
nerve-root compression were usually severe, even in the patients with a
small disc protrusion. The severity of the clinical findings appeared to be
due to the reduced mobility of the anomalous roots. Adequate surgical
decompression led to satisfactory final results in all nine patients.