PMC3931141_01
Preoperative radiographic and MRI images: (a) anteroposterior radiograph of the lumbar spine showing degenerative changes and scoliosis with convexity to the right (b) lateral radiograph of the lumbar spine demonstrating grade I degenerative spondylolisthesis at L4/5 level (c) sagittal T2W MRI of the lumbar spine showing severe left-sided stenosis at L4/5 and L5/S1 levels (d) axial T2W MRI showing severe rightsided stenosis at L4/5 level
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F1
Initial radiographs of lumbar spine revealed degenerative scoliosis with convexity to right from L1 to S1 with a sideway slip at L4/5 and rotation from the L3/4 level upward in the vertebrae [Figure 1a and b]. Magnetic resonance imaging (MRI) scans preoperatively revealed severe stenosis at L4/5 and L5/S1 [Figure 1c and d].
Postoperative anteroposterior (a) and lateral (b) radiographic images demonstrating clear decompression and normal sagittal alignment
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F2
Technologies (DMT), Yarm UK] at L3 and L4 levels and a posterior lumbar interbody fusion using 11 mm cages (SABER CFRP I/F cage system, DePuy spine, Warsaw, In, USA) using a less invasive approach at L4/5 and L5/S1 levels [Figure 2]. There were no intraoperative complications.
Postoperative MR images of the lumbar spine: (a) Axial T2weighted image showing high signal intensity confirming the collection (white arrow) (b) axial T1weighted image showing low signal intensity over the posterior aspect of the psoas muscle (white arrow); (c) axial T2weighted MR image demonstrating communication of collection with operative collection (white arrow) (d) axial T1 gadolinium-enhanced image showing the low intensity zone over the collection (white arrow)
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F3
MRI [Figure 3] of the lumbar spine revealed a large collection measuring 7.6 x 4.3 x 3.3 cm adjacent to the L4-S1 vertebral bodies. This collection was communicating with the extradural hematoma through the left L4 exit foramen [Figure 3c].