The patient was operated by me first in 01-May-2008 for extruded disc L4-5 with left foraminal occlusion. The patient then came last time 19-November-2011 after falling down 1 month ago with LBP and left sciatica, but in examination, she had manifestations of severe cervical canal stenosis, which was confirmed in MRI cervical spine with malacia of the spinal cord at C3-4, for what she was operated 27-December-2011 to decompress C3-4 and C5. The patient showed improvement of the power of the left upper limb, but continued to complain of left sciatica, with urgency and frequency. Cystoscopy done 09-January-2012 confirming the presence of urethral stenosis and she has only one kidney from childhood,

On examination, the patient is unable to walk due to severe left sciatica and she progressed weak dorsiflexion left foot 4/5 only the evening of 09-January-2012, for what it was decided to operated her.

The MRI of the lumbar spine, which were done 10-December-2011 showing ganglion of the left L4-5 lateral mass compressing the left L5 root. It could be a recurrence of the operated disc, but the patient came previously 03-October-2010 with left sciatica and MRI done 09-October-2010 showing the same ganglion or recurrence , but she was treated conservatively and she did well after that.

The medial wall of the left L4-5 facet was reached. Drilling of the medial wall for about 3 mm to expose the ganglion, which was compressing the left L5 root. The area was full of scar and the root was very thin due to severe compression. The ganglion was removed after what the root regained a relax position. There was a tiny tear in the root, which was abutting the ganglion. It was stitched by 6 zero nylon. The disc space was inspected and further intradiscal cleaning was done to minimize the postoperative recurrence. A piece of muscle was used to cover the dural defect in the lateral wall of the root, aided with scar transferred from the nearby with pedicle to fill the gap.

Routine closure of the wounds. Smooth postoperative recovery with disappearance of the left sciatica.

The patient was complaining of left sciatica and she was initially operated for cervical canal stenosis. This was done so as to avoid possible quadriplegia in case of positioning of the patient in prone position for lumbar disc surgery.

The ganglion was not large enough, but it seems that it was compressing the root in pin-point fashion, causing this agonizing sciatica.