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02-APRIL-2008  JUMA'A RAMADAN ABU-ASFAR  62 YEARS  LUMBAR CANAL STENOSIS L3-4 WITH CALCIFIED GANGLION RIGHT L3-4 FACET JOINT.

Anamnesis:

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The patient came to the clinic 31-March-2004 complaining of neck pain for 8 months with radicular pain left upper limb.

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The patient was operated by me 1986 for PLD L4-5.

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On examination at hat time: the patient had hypalgesia both C5 roots territories and left median nerve distribution and left lower limb below the knee with weak right upper limb and left quadriceps muscle. MRI cervical spine done 31-March-2004  showed PCD C3-4, and he was advised to undergo surgery and he performed it elsewhere.

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The patient then came 25-February-2008 complaining of LBP with intermittent claudication with numbness both lower limbs for 45 days. He could not walk more than 200 meters.

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On examination: Hoffmann sign was positive in the left upper limb, with scoliotic stance. The patient had hypalgesia left S1 root territory and weak dorsiflexion left foot.

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MRI lumbar spine performed 10-March-2008 showed showed severe stenosis L3-4 with calcified ganglion arising from the right facet joint of L3-4.

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Decompressive laminectomy of L3 was performed and the calcified ganglion was drilled off and foraminotomy of right L4 root was performed. The flail upper edge of the L4 lamina was removed also. The ligamentum flavum between the calcified ganglion and the dura was severely adherent to the dural and to the root.

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Routine closure of the wound with smooth postoperative recovery.

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Immediate improvement of the power of the left foot.

Comments

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Lumbar canal stenosis could be the result of many elements and in this case, it was the calcified ganglion arising from the right facet joint. If the ganglion is still new and gelatinous in consistency, it is preferable to wait, until the gelatinous fluid shrink by time. But in this case it was calcified, that expectancy for shrinkage is null.

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