PMC5680665_01
Sagittal MR T1-weighted, T2-weighted (a) T1-fat saturated post contrast (b), axial T1-post gadolinium (c), and axial T2-weighted (d) images demonstrating a T1 hypointense, T2 hyperintense enhancing mass centered in the L3 vertebral body with significant epidural and retroperitoneal extension and decreased marrow signal in L3 vertebral body (e)
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F1
Established T1 (hypointense), T2 (hyperintense), and T1 enhanced magnetic resonance (MR) studies documented a large tumor centered at the L3 level with marked epidural compression and bilateral retroperitoneal extension [Figure 1].
Post Stage 1 images on lateral plain film (a), AP plain film (b), axial CT (c), and midsagittal CT (d)
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F2
Pedicle screws were then connected with two rods and a crosslink [Figure 2].
Surgical view after posterior element removal. Bilateral L2 and L3 nerve roots are visualized (a). Ventral epidural Gortex patch. Anterior view of the removed L3 vertebral body with attached left sided tumor (b). Lateral view of the removed L3 vertebral body with attached left sided tumor and ventral epidural gortex patch (c). Removed posterior elements (d)
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F3
T11 and T12 were taken, the psoas muscle was mobilized, and the anterolateral disc spaces of L2/3 and L3/4 were exposed allowing retroperitoneal tumor resection utilizing annulotomies and diskectomies [Figure 3]. The defect was reconstructed with an expandable cage and lateral plate, whereas the harvested rib was used to create a strut graft next to the cage for early bone fusion [Figure 4].
Final construct shown on AP (a) and lateral (b) plain films
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F4
T11 and T12 were taken, the psoas muscle was mobilized, and the anterolateral disc spaces of L2/3 and L3/4 were exposed allowing retroperitoneal tumor resection utilizing annulotomies and diskectomies [Figure 3]. The defect was reconstructed with an expandable cage and lateral plate, whereas the harvested rib was used to create a strut graft next to the cage for early bone fusion [Figure 4].