Spontaneous Migration of a Redundant Nerve Root Accompanied by Absorption of Lumbar Disk Herniation

Abstract

A redundant nerve root is defined as a large, elongated and tortuous nerve root commonly associated with severe lumbar spinal canal stenosis. Elongation of nerve roots as a result of mechanical trapping at stenotic level is assumed to be a possible mechanism. Here we present a case in a patient who showed a redundant nerve root above the level of a lumbar canal stenosis caused by disk herniation and redundancy spontaneously migrating to a lower lumbar stenosis level accompanied by absorption of the herniated disk as shown by magnetic resonance imaging (MRI). A 67-year-old Japanese woman presented with bilateral thigh/leg pain and intermittent claudication. A midsagittal T2-weighted MR image of the lumbar spine revealed severe spinal canal stenosis at the L3-4 and L4-5 levels. At the L3-4 level, central disk herniation compressed the dural tube. An MR image revealed redundant nerve roots just cranial to the severely compressed L3-4 level. A follow-up MRI study revealed regression of disk herniation at the L3-4 level. In contrast, there was no significant change of the stenosis at the L4-5 level. Sagittal T2-weighted MR imaging at follow-up revealed redundant nerve roots just cranial to the L4-5 level, whereas the redundant nerve roots cranial to the L3-4 level had disappeared. The MRI findings of the present case support the "squeeze" hypothesis as causative of redundant nerve roots.