The patient came to the clinic 15-August-2011 complaining of LBP for 1 month with weak right lower limb after lifting heavy object. He is using walker for 2 weeks.

MRI lumbar spine done 13-August-2011  showing ruptured ganglion of the right L3-4 with severe compression of the lumbar canal at this area.

On examination: the patient in wheel chair, that it was impossible to evaluate Romberg and scoliotic stance. There is weak dorsiflexion right foot -3/5, left foot 3/5, planterflexion right foot 3/5, left foot +4/5. Hypalgesia right L5 and S1 territories. SLRS was 90 degrees both sides without pain.

Using C-arm, the L3-4 level was identified and partial flavotomy around the suggested ganglion was undertaken at L3-4. After removing sufficient amount of the flavum, a blue mass appeared, which was hemorrhagic and stuck to the dura, but separable. Total removal of the mass, which was arising from the right L3-4 facet was achieved, after what the dura became lax and free. The mass was sent for histological verification, to rule out malignancy.

Routine closure of the wound.  Smooth postoperative recovery  with improvement of the power of both feet

Rupture of the ganglion from the facets of the vertebral column is not uncommon, but most of them can be treated conservatively.

In this case, surgical intervention was mandatory, to prevent the escalation of further deterioration of the neurological status.