PMC7276604_01
Pre-operative imaging. (a)Plain lateral X-ray in flexion position. T12 vertebral body (white arrow) was severely collapsed. (b)T2-weighted magnetic resonance imaging sagittal image. Large bony defect at T12 vertebral body (white arrow) in supine position. (c)Computed tomography (CT) horizontal image of T12 in spine position. Defect of anterior cortical wall was seen (arrowhead). (d)CT sagittal image at flexion position. The fragment of posterior wall of T12 was significantly retropulsed into the spinal canal.
JOCR-9-50-g001.jpg
PMC7276604_01_JOCR-9-50-g001.jpg
F1
Plain radiography in flexion position revealed a markedly compressed T12 vertebral body (Fig. 1a), and T2-weighted magnetic resonance imaging in the supine position revealed a large bony defect in the vertebral body (Fig. 1b). In addition, computed tomography (CT) in supine position revealed and a large cortical defect in the anterior vertebral wall (Fig. 1c) and CT in flexion position revealed that a bone fragment of the posterior vertebral wall was markedly retropulsed into the spinal canal (Fig. 1d).
Aspiration of bone marrow from vertebral body. A 10-cc syringe for aspiration of bone marrow, A 20-cc syringe including with Affinos .
JOCR-9-50-g002.jpg
PMC7276604_01_JOCR-9-50-g002.jpg
F2
Bone marrow blood (2-3 mL/vertebral body) was collected with high-pressure aspiration (Fig. 2 ). The bone marrow blood was transferred into another 20-cc syringe filled with Affinos  granules to impregnate them (Fig. 2 ).
Post-operative imaging of X-ray. (a)Immediately after surgery (prone position). Vertebroplasty was performed at T12 and posterior instrumentation was performed from T10 to L3.(b)One year (standing position). Vertebral height was well maintained.
JOCR-9-50-g003.jpg
PMC7276604_01_JOCR-9-50-g003.jpg
F3
T12 vertebral body, and rods exactly reproducing the spinal alignment in the prone position were locked to the pedicle screws (Fig. 3a). To prevent screw back-out due to osteoporosis, two 5-mmwidth super-high-molecular-weight polyethylene tapes (Nesplon , Alfresa Pharma, Osaka, Japan) each were passed under the laminae of T12T10and L3 to fasten the rods for reinforcement. One year after surgery, X-ray in the standing position revealed that vertebral height was well maintained (Fig. 3b).
Post-operative computed tomography. (a)Three months. The cortex of vertebral anterior wall was well regenerated (arrowhead)and bony fusion was achieved.(b)Six months. Absorption of Affinos  was partially began and the cortex of vertebral anterior wall was thickened (arrowheads).and bony fusion was achieved.(c)One year. Absorption of Affinos  was progressed and bony regeneration was advanced.
JOCR-9-50-g004.jpg
PMC7276604_01_JOCR-9-50-g004.jpg
F4
We determined that bone union was completed (Fig. 4a). Simultaneously, the cortex of the anterior vertebral wall was found to be further regenerated (Fig. 4b). Autologous bone was found to be further regenerated in the vertebral body (Fig. 4c).