Lumbar endoscopic decompression in the presence of unexpected conjoined nerve root pathology: technical benefits and case illustrations

Conjoined nerve roots (CNRs) represent a common yet frequently underdiagnosed congenital anomaly of the lumbar spine that increases the risk of iatrogenic injury. We present two cases of incidentally discovered CNRs successfully managed with full endoscopic spine surgery (ESS). While often missed on preoperative imaging, ESS provides a distinct advantage in managing these variants due to its magnified, high-definition visualization through a minimally invasive approach. This technique allows for the precise identification and safe decompression of unexpected CNRs, serving as both a diagnostic and therapeutic tool. The enhanced clarity and anatomical preservation offered by ESS highlight its vital role in navigating anomalous anatomy, positioning it as a cornerstone for the future of minimally invasive spine surgery.