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01-MAY-2008  LATIFEH SHAKER JARRAR  73 YEARS  SEVERE LCS L2-3, 3-4 AND L4-5 WITH LEFT L4-5 RECESS SYNDROME DUE TO GANGLION FROM FACET JOINT.

Anamnesis:

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The patient came to the clinic 27-April-2008 complaining of LBP with left sciatica for three years. Exacerbation the last two months and inability to walk the last 4 days. She was complaining of continuous numbness both feet.

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The patient is a known hypertensive for 3 years and she underwent labcholi 20 years ago and bilateral CT-release 15 years ago and she is in Xeroxat and Depakine for 12 years.

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On examination: the patient was unable to stand for evaluation of scoliotic stance or gait assessment.  SLRS was 50 degrees in the right and 40 degrees in the left with pain. He had weak dorsiflexion both feet -4/5.

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MRI performed 28-April-2008 showed severe lumbar canal stenosis L2-3, L3-4 and L4-5 with left lateral recess syndrome at L4-5 with ganglion compressing the root arising from the left L4-5 facet joint.

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Decompressive laminectomy of L3-4 and partial of L2 and L5 was done. Foraminotomy of all roots was achieved in the area. The left L4-5 facet ganglion was removed and inspection of the L4-5 annulus fibrosis was done. The root was hanging free.

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Routine closure of the wound with smooth postoperative recovery.

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Considerable improvement of the power of both feet.

Comments

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Lumbar canal stenosis is a progressive disease and surgery must be performed the sooner the better, if the clinical manifestations are escalating.

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Lumbar canal stenosis is not a cause for radicular pan, and the cause must be found and resolve, as in this case the ganglion, which was compressing the left L5 root.

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