PMC7484695_01
(a) Lateral radiograph and (b) axial and (c) coronal CT reconstructions showed a collapsed nonhealing L1 vertebral body with destruction of both upper and lower endplates. (d, e) T11/T12 and T12/L1 transforaminal debridement using curettes to remove disc material and cartilage. (f) Antibiotic impregnated allograft. (g) Autologous bone graft from posterior iliac crest.
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After removal of the corticocancellous strips, gouges or curettes were used to harvest additional cancellous bone (Figure 1(g)).
(a, b) After transforaminal debridement and impaction of bone graft, posterior pedicle instrumentation using cement-augmented pedicle screws was placed from T11-L3. At three years follow-up, the fusion mass between L1/L2 (c) and T12/L1 (d) was solid.
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T12/L1 and L1/L2 transforaminal debridement and impaction of mixed autologous bone and allograft (Figures 1(f) and 1(g)) were performed for T12-L1-L2 interbody fusion (Figures 1(d) and 1(e)), followed by posterior instrumentation using cement-augmented pedicle screws from T11-L3 (Figures 2(a) and 2(b)). At three years follow-up, the fusion mass between T12/L1 and L1/L2 was solid, and the patient had minimal pain (Figures 2(c) and 2(d)).
PMC7484695_02
(a) Lateral radiograph and (b) axial and (c) coronal CT reconstructions showed a collapsed nonhealing L1 vertebral body with destruction of both upper and lower endplates. (d, e) T11/T12 and T12/L1 transforaminal debridement using curettes to remove disc material and cartilage. (f) Antibiotic impregnated allograft. (g) Autologous bone graft from posterior iliac crest.
CRIOR2020-8873350.001.jpg
PMC7484695_02_CRIOR2020-8873350.001.jpg
fig1
After removal of the corticocancellous strips, gouges or curettes were used to harvest additional cancellous bone (Figure 1(g)).
(a) Lateral radiographs showed a collapsed nonhealed L1 fracture and local kyphosis (39 degrees). Sagittal CT (b) and MRI (c) show a retropulsed bone fragment which compromised the spinal canal.
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Radiographs showed a collapsed nonhealed L1 fracture and 39 degrees of local kyphosis (Figure 3(a)). CT and MRI showed L1 vertebral body destruction similar to Kummell's disease, with destruction of the inferior endplate (Figures 3(b) and 3(c)). A retropulsed bone fragment was observed in the canal (Figure 3(c)).
(a) Postoperative kyphotic angle improved immediately post operatively from 39 degrees to 12 degrees. (b) Allograft was impacted at the L1/T12 disc level. (c) The kyphotic angle stabilized at 20 degrees at three years follow-up. (d) At three months follow-up, back pain VAS had improved from 8 to 1 and the patient was able to bend forward without notable pain.
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T12/L1, followed by transforaminal interbody impaction of allograft into the T12/L1 disc space (Figure 4(b)). The postoperative kyphotic angle improved from 39 degrees to 12 degrees (Figure 4(a)). At three months follow-up, her VAS back pain had improved from 8 to 1, and she was able to bend forward without pain (Figure 4(c)). The kyphotic angle was 20 degrees at three years follow-up (Figure 4(d)), at which time X-ray showed solid union and instrumentation remained intact. The patient has no back pain and has kept regular radiographic and clinical follow-up to 3 years.