PMC6332745_01
Case 1: (A, B) and (F, G) Antero-posterior and lateral views at first visit and post-OLIF surgery, respectively. The local scoliosis shown at the first visit was corrected to some extent post-OLIF (F). The white dashed line at L2-3-4 in (B) indicates the local kyphosis, which improved post-OLIF surgery as seen in (G). (C-E) Presurgical T2-weighted sagittal magnetic resonance imaging (MRI) and axial sections at L2-3 and L3-4, respectively. Modic type 3 change at L3-4 and severe canal stenoses were detected at both L2-3 and L3-4
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Imaging studies showed lumbar spinal canal stenoses at L2-3 and L3-4, intervertebral degeneration classified as Modic type 3, and local kyphoscoliosis at L2-3-4 intervertebral levels(Figure 1A-E).7 Conservative therapy did not alleviate his symptoms.
PMC6332745_02
Case 2: (H) Lateral view at first visit. (I, J) Initial T1 and T2-weighted sagittal MRI. Severe canal stenosis and some mild signal changes like the Modic type 3 on endplate of the caudal side were detected at L3-4. (K) Lateral view at 2 y after first OLIF. (L, M) T1 and T2-weighted sagittal MRI at 2 y post-OLIF showed canal stenosis and no obvious Modic change at L2-3. (N, O) Antero-posterior and lateral views after second OLIF at L2-3
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Radiological evaluation showed canal stenosis and some mild signal changes like the Modic type 3 on endplate of the caudal side at L3-4 were detected. (Figure 2H-J) We performed OLIF surgery at the L3-4 level accompanied by posterior decompression and fixation using PS. X-ray showed relatively narrowed intervertebral space, and magnetic resonance imaging (MRI) revealed spinal canal stenosis and no obvious Modic change (Figure 2K,M). We performed another OLIF (on the same side as the previous OLIF surgery), posterior decompression, and insertion of PS (Figure 2N,O) at L2-3.
PMC6332745_03
Case 3: (Q) Lateral lumbar plain radiograph at first visit. (R) Lateral view at 2 y post-L1-2 transforaminal lumbar interbody fusion (TLIF). (S, T) T1 and T2-weighted sagittal section and T2-weighted axial section of MRI at L3-4, 2 y post-TLIF showed Modic type 3 at L1-2 level and no obvious signal change on endplates at L2-3 nor L3-4. No significant canal stenosis was detected. (V, W) Antero-posterior and lateral views after oblique lateral interbody fusion (OLIF). The dashed line at L2-3-4 in (R) indicates the local kyphosis, which improved after OLIF surgery as seen in (W)
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A 69-year-old man who had undergone L4-5 and L5-S1 PLF surgery at a local civilian hospital 5 years previously visited our hospital complaining of severe low back and right leg pain, which was refractory to conservative therapy (Figure 3P). The Modic type 3 change was detected only at L1-2, and no obvious signal changes at L2-3-4 were observed (Figure 3R-T). We diagnosed local malalignment as the cause of his severe pain and performed OLIF surgery for L2-3 and L3-4 via a single incision about 6 cm wide in the left lateral abdominal wall, supplemented by posterior percutaneous pedicle screws (PPS) and an extended rod system (Figure 3V,W).