PMC5352865_01
Preoperative radiography of the lumbar spine. Anteroposterior (AP) view (a); lateral view (b). Ossification of the yellow ligament (OYL) is seen at L3/4 and anterior spondylolisthesis of L4 vertebra, with concomitant ossification of the posterior longitudinal ligament.
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Plain radiography of the lumbar spine demonstrated OYL at L3/4 and anterior spondylolisthesis of L4 vertebra, with concomitant ossification of the posterior longitudinal ligament (OPLL) (Figure 1).
Preoperative magnetic resonance imaging. Sagittal T1-weighted image (a); sagittal T2-weighted image at the midspinal canal (b); axial T2-weighted image at the L3/4 level (c); axial T2-weighted image at the L4/5 level (d). Lumbar canal stenosis is seen at the L3/4 and L4/5 levels, with severe stenosis at L3/4.
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Magnetic resonance imaging showed lumbar canal stenosis at levels L3/4 and L4/5 and severe stenosis at L3/4 (Figure 2).
Preoperative computed tomography (CT) myelography. Sagittal image at the midspinal canal (a); axial image at the L3/4 level (b); axial image at the L4/5 level (c). OYL and complete block are seen at the L3/4 level.
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Computed tomography (CT) myelography revealed OYL and complete block at level L3/4 (Figure 3).
Postoperative radiography of the lumbar spine. AP view (a); lateral view (b). Lateral lumbar interbody fusion of L3/4 and L4/5 was performed at the initial surgery, and posterior decompression fixation using pedicle screws from L3 to L5 was performed at the second surgery.
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We performed posterior decompression under microscopy guidance, after completing posterior fixation with pedicle screws from L3 to L5 (Figure 4).
CT 12 months after surgery. Sagittal image at the midspinal canal (a); coronal image at the midvertebral body (b). Bridging bone formation is present at the edge of the cage inserted at the L3/4 and L4/5 intervertebral spaces.
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CT revealed bridging bone formation at the edge of the cage at the L3/4 and L4/5 intervertebral spaces (Figure 5). Clinical evaluation was performed at 1 year after surgery: the JOA score was 27/29 (3-3-3, 2-2-2, 2-2-2-1-2-1-2, 0), and the JOABPEQ score was 100 points for lumbar back pain, 50 points for lumbar function, 100 points for walking ability, 100 points for social-life function, and 54 points for mental health.