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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SALHA SALEH JALAL 52 YEARS LUMBAR CANAL STENOSES
L4-5 WITH LEFT LATERAL RECESS SYNDROME.
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to the clinic 31-May-2010 complaining of LBP for
three months with left sciatica down to the
lateral malleolus. MRI performed
28-February-2010 showing bulge L3-4 and severe
lumbar canal stenosis L4-5 and left lateral
The patient is
unable to walk more than 100 meters. On
examination: there is exaggerated scoliotic
stance with drop left foot 0/5 and weak
dorsiflexion right foot and planterflexion left
foot -4/5. There is hypalgesia left L5 and S1
MRI of the lumbar
spine performed 01-June-2010 confirming the
Decompressive laminectomy of L4 and partial of
L5 and flavotomy of L3-4 was achieved. Extended
foraminotomy of left L5 root was done. After
decompressing the root a cystic dural structure
appeared lateral to the root. It was inspected
and studied so as not to miss and extruded disc
or ganglion from the facet. It became clear that
it was a Tarlov cyst, which shrunk and
disappeared after bipolar coagulation.
Inspection of the annulus fibrosis was negative
for disc extrusion. Check for instability at the
start and the end of the operation was also
Routine closure of the wound and smooth postoperative recovery with
dramatic improvement of the power of both feet.
Tarlov cysts are usually
below the dorsal root ganglion and they are
frequently seen in MR myelography.
This Tarlov type lesion was
the lateral side of the axilla of left L5 root,
mimicking ruptured ganglion or extruded disc
material. The surgeon must be careful in
evaluating these findings and Tarlov cyst must
be considered in the differential diagnosis as
in this case. This finding is extremely rare,
but must be kept in mind.
Notice: Not all operative activities
can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also
escaped from the plan .