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22-DECEMBER-2002 AMAL SULAYMAN SAWAQED 48
YEARS MIGRATED SYNOVIAL CYST LEFT L4-5 FACET WITH SEVERE COMPRESSION.
Anamnesis
The patient came to the clinic
21-December-2002 complaining of LBP and
left sciatica down to the left L4 root territory for
2 years with progressive course. MRI lumbar
spine done 11-December-2002 showing a mass in
the left L4-5 facet medial wall.
On examination: the patient
is limping
with scoliotic stance . SLRS was 45
degrees left side with pain. There is severe
weak dorsi and planterflexion left foot with hypalgesia
left L5 and S1 roots
territories left side. She has bilateral CTS
with neck pain for 7 years. There is urgency and
frequency for 1 year.
The patient was sent for
investigations and MRI lumbar spine showed
lumbar canal stenosis L3-4 and L4-5 with
calcified extrusion L5-S1.
Decompressive laminectomy
L4-5. Foraminotomy
left
L5 root. All the compressing elements including
the synovial cyst were removed from the left
side. The torn dura was repaired by nylon 6 zero
water-tightly. The
patient was put in Reverse Trendelenburg
position with Valsalva maneuver and
hyperventilation. No CSF leak. A free fat was
harvested from the subcutaneous layer and
covered the exposed parts of the root. to
minimize postoperative scarring. Routine closure
of the wound. Smooth postoperative recovery. The
power of the left foot normalized.
FOLLOW UP
The patient
came to the clinic 04-January-2003 with clean wound
with no motor, nor sensory deficit.
Comments
The patient has
extradiscal compression fro the structures of
the left L4-5 facet causing severe compression.
Surgical decompression is the best to offer.
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