Most of the site will reflect the ongoing surgical activity of Prof. Munir Elias MD., PhD. with brief slides and weekly activity. For reference to the academic and theoretical part, you are welcome to visit
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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
The patient came to the
clinic 31-March-2004 complaining of neck pain
for 8 months with radicular pain left upper
The patient was operated by
me 1986 for PLD L4-5.
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.
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.
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
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.
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.
Routine closure of the wound
with smooth postoperative recovery.
Immediate improvement of the
power of the left foot.
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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