PMC9912182_01
Three-dimensional reconstruction of CT scans in local hospital. Scapular fractures and rib fractures (A), L3 spondyloptosis combined with proximal femoral fracture and lumbar vertebra fracture (B) were enclosed by the red ellipse.
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Radiological examinations in local hospital revealed multiple injuries, comprising L3 vertebra fracture-dislocation, scapular fracture, rib fractures, and left femoral shaft fracture (Fig. 1).
Detailed L3 spondyloptosis and its relationship with anterior large vessels. Complete anterior spondyloptosis of L3 was confirmed by two separate intensified or non-intensified CT planes (A and B), sagittal scan (C) and reconstruction images (D). Further CT angiography was conducted, compression of large vessels comprising both inferior vena cava and abdominal aorta were discovered from several CT axial planes (E) and reconstruction images (F).
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L3 vertebra was downright parallel to L4 vertebra (Figs. 2A-C). L3 vertebral fracture was confirmed by three-dimensional reconstruction (Fig. 2D). As a result, compression of both inferior vena cava and abdominal aorta was implied on consecutive CT axial planes and CT angiography (Figs. 2E and F).
The placement of vena cava filter. To prevent thrombosis caused by vascular stenosis, a vena cava filter was imbedded into the inferior vena cava and the position was ensured (A and B).
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Therefore, inferior vena cava filter was implanted through the internal jugular vein (Figs. 3A and B).
First posterior internal fixation. To stabilize the spinal alignment balance, posterior bilateral pedicle screw fixation and rods construction were performed on segment L1, L2, L4, and L5 vertebral bodies. Intraoperative fluoroscopy (A) and postoperative radiography, coronal (B) and sagittal (C), demonstrated successful restoration. Cut plane (D), coronal (E) and sagittal (F) CT scan revealed a mild retraction of L3 vertebra.
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To stabilize the spinal alignment, posterior bilateral pedicle screw fixation and rods construction were performed on segments L1, L2, L4, and L5 vertebral bodies in prone position (Figs. 4A-C).
Second anterior internal fixation. We performed vertectomy of the fractured L3 vertebrae body (A) and placed a cage between L2 and L4 (B). Morselized bone harvested from L3 was packed into cage. The spinal alignment was restored as implied by postoperative radiography plain of coronal (C) and sagittal (D).
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Then the completely fractured L3 vertebrae body was removed en bloc (Fig. 5A) and a cage of 26 mm in diameter with cancellous bone from L3 vertebrae was implanted between L2 and L4 (Fig. 5B). Postoperative radiography (Figs. 5C and D) demonstrated a restored stability of the spine and decompression.
Rehabilitation functions at postoperative 6-month follow-up. At postoperative 6-month, this patient was identified to have incomplete neurological improvement (A and B). Postoperative radiography plain (C) and CT scan (D) demonstrated a stable spinal alignment.
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The patient had motor strength scores of 4/5 in left hip flexors and knee extensors, and 3/5 in foot dorsiflexion and plantar flexion, while 2/5 in right lower extremities (Figs. 6A and B). Plain radiography (Fig. 6C) and CT sagittal reconstruction (Fig. 6D) indicated a stabilized spinal alignment balance.