PMC6786501_01
Axial cut at T3 level on CT scan (a), midsagittal cut on CT scan (b), as well as T2 weighted sagittal MRI scan (c) images of the thoracic spine of a 70-year-old male patient (case 1) showing ossification of the thoracic posterior longitudinal ligament behind T2 to T4 levels with anterior compression of the cord and associated signal intensity changes at the same level
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Fig1
MRI of the thoracic spine with whole spine screening and CT scan of the thoracic spine suggested thoracic stenosis with OPLL (Fig. 1).
Preoperative (a) and postoperative (b) T2 weighted MRI images of the patient (case 1) showing adequate fall back of the cord. CSF column could be appreciated in front of the involved spinal cord. The segmental kyphosis at the level of instrumentation (T1 to T5) decreased from 14.60 preoperatively to 6.20 postoperatively. Preoperative (c) and postoperative (d) X-ray images of the patient (case 1) showing that the segmental kyphosis between T2 to T5 decreased from 130 preoperatively to 6.30 postoperatively (we chose T2 level as the superior endplate of T1 vertebra could not be appreciated well on lateral pre and postoperative X-ray images)
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Fig2
Postoperative X-rays showed appropriately placed screws and adequate fixation of the implant with relative segmental lordosis at the index level (Fig. 2). Postoperative MRI showed adequate relative lordosis of the involved segment and CSF column anteriorly suggesting adequate decompression (Fig. 2).On follow up assessment at 6 months postoperatively, he had an improved Nurick score and was able to walk with slight difficulty (Nurick II).
PMC6786501_02
a Midsagittal cut on CT scan of the thoracic spine of a 68-year-old woman (case 2) showing degenerative changes in the thoracic spine, kyphotic alignment of the thoracic spine, and mobile intervertebral disc spaces in the thoracic spine. b Sagittal T2 weighted MRI of the thoracic spine of a 68-year-old woman (case 2) showing multilevel intervertebral disc prolapse (T8-T9/T9-T10 and T10-T11 levels) with signal intensity changes at T9-T10 and T10-T11 levels suggesting thoracic myelopathy. c Intraoperative C-arm image of the thoracic spine of the patient (case 2) showing lordotic rod fixation. d Intraoperative clinical image of the patient (case 2) showing decompressed thoracic cord using the microsurgical technique and instrumentation at the same level
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Fig3
The symptoms and signs suggested thoracic myelopathy with Nurick grade III.CT scan and MRI scan revealed a multilevel intervertebral disc prolapse at T8-T9/T9-T10 and T10-T11 level with signal intensity changes at T9-T10 and T10-T11 levels (Fig. 3). The surgery was performed by the same procedure as described above with fixation from T8 to T11 levels (Fig. 3). The postoperative X-ray and MRI images showed adequate relative lordosis and decompression of the thoracic spinal cord (Fig. 4).
Preoperative (a) and postoperative (b) T2 weighted MRI images of the patient (case 2) showing the decompressed spinal cord. The segmental kyphosis at the level of instrumentation (T8 to T11) decreased from 12.60 preoperatively to 3.30 postoperatively. Preoperative (c) and postoperative (d) X-ray images of the patient (case 2) showing that the segmental kyphosis between T8 to T11 decreased from 12.80 preoperatively to 3.60 postoperatively
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Fig4
The symptoms and signs suggested thoracic myelopathy with Nurick grade III.CT scan and MRI scan revealed a multilevel intervertebral disc prolapse at T8-T9/T9-T10 and T10-T11 level with signal intensity changes at T9-T10 and T10-T11 levels (Fig. 3). The surgery was performed by the same procedure as described above with fixation from T8 to T11 levels (Fig. 3). The postoperative X-ray and MRI images showed adequate relative lordosis and decompression of the thoracic spinal cord (Fig. 4).
Intraoperative C-arm images (a, b) of a 71-year-old female (case 3) with ASA-grade III with symptoms and signs of thoracic myelopathy showing the segmental relative lordosis achieved at the instrumented level after application of prebent rods. the relative position of the base of the screw heads (marked with blue arrows) can guide the intraoperative assessment of relative lordosis at the instrumented level. Preoperative (c) and postoperative (d) sagittal MRI images show achievement of 10 0 of relative lordosis at the instrumented level (T11-T12). Adequate decompression with continuous anterior CSF column could be appreciated in the postoperative images as compared preoperatively
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Fig5
Preoperative (a) and postoperative (b) T2 weighted MRI images of a 71-year-old male (case 4) with dilated cardiomyopathy who presented to us with severe progressive thoracic myelopathy showing adequate fall back of the cord. CSF column could be appreciated in front of the involved spinal cord. The segmental kyphosis at the level of instrumentation (T10 to T12) decreased from 11.90 preoperatively to 60 postoperatively. Preoperative (c) and postoperative (d) X-ray images of the patient (case 4) showing that the segmental kyphosis between T10 to T12 decreased from 140 preoperatively to 50 postoperatively. He had a good improvement in symptoms postoperatively
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Fig6