PMC5504926_01
X-ray image of the spine at the first visit. Deformation of L2 vertebral body after posterior fixation surgery.
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We confirmed deformation of the L2 vertebral body by the initial radiography and MRI from the previous facility revealed hyperintensity/hypointensity of the L1, L2, and L3 vertebral bodies and compression of the spinal canal by the tumor at the same level (Figures 1 and 2).
MRI findings. Brightness changes in the L1, L2, and L3 vertebral bodies and compression of the spinal canal by the tumor at the same level.
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We confirmed deformation of the L2 vertebral body by the initial radiography and MRI from the previous facility revealed hyperintensity/hypointensity of the L1, L2, and L3 vertebral bodies and compression of the spinal canal by the tumor at the same level (Figures 1 and 2).
CT images. Vertebral arch (T12-L3) after posterior fixation surgery indicated complete bone union and bridge formation.
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After posterior fixation surgery, the vertebral arch (T12-L3) in a CT scan indicated a complete bone union and bridge formation (Figure 3).
Uptake for metastases in the posterior element was not observed in PET/CT.
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PET/CT revealed no uptake in the posterior element, thus demonstrating no residual metastasis (Figure 4).
Postoperative CT images. The dashed line shows the approach route. The painted area indicates the excision area.
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Then, we set an appropriate length of both the mesh cage and autologous bone in the space after anterior element excision, inserted the screws into the T12 and L4 vertebral bodies, fastened the plate, and performed anterior fixation (Figure 5).
X-ray image of the spine after surgery.
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The possibility of implant dislodgement due to osteopenia was addressed by performing short posterior fixation (2 above 2 below) and resection of the anterior affected portions of L1-L3 with the use of mesh cage and anterior plate (Figure 6).