PMC3913434_01
Preoperative imagiologic study; involvement of T8 by the giant-cell tumor as presented in plain radiograph (A), CT scan (B) and MRI (C and D). Notice the tumor mass protruding into the vertebral canal.
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She performed a computed tomography (CT) scan and magnetic resonance imaging (MRI), which better defined the bone involvement and already revealed invasion of the medullary canal (Fig. 1).
Intraoperative photographs; after total en bloc spondylectomy (A), anterior-column reconstruction was accomplished with placement of a titanium cage with structural allograft (B) and was complemented with pedicle screw-rod fixation (C). (D) Resected vertebra.
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T8 by a posterior-only approach was performed (Fig. 2). The operation followed the technique proposed by Tomita et al. and was complemented with anterior-column reconstruction with a titanium mesh filled with structural allograft, as well as pedicle screw instrumentation, from T6 to T10 (Fig. 3).
Postoperative radiographic appearance.
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T8 by a posterior-only approach was performed (Fig. 2). The operation followed the technique proposed by Tomita et al. and was complemented with anterior-column reconstruction with a titanium mesh filled with structural allograft, as well as pedicle screw instrumentation, from T6 to T10 (Fig. 3).
Bilateral hemothorax requiring drainage.
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A CT scan confirmed bilateral hemothorax requiring bilateral thoracentesis (Fig. 4), after which she immediately recovered from the previous symptoms. 
Postoperative thoracic CT scan; large septated empyema, extending from the surgical site to both pleural cavities, was found to be the cause of deterioration of the patient's general condition.
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A new CT scan was performed, revealing a moderate fluid collection in both lungs, compatible with empyema (Fig. 5).
Revision procedure; a thoracotomy was performed for pus drainage and debridement, as well as removal of the anterior cage and allograft (A). A tricortical iliac bone autograft was used to maintain anterior-column stability (B). Postoperative radiographic study (C and D).
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Due to the ongoing postoperative infection, a new operation was undertaken with surgical debridement of the infected tissues, allograft and titanium mesh extraction, which were replaced by iliac crest tricortical autograft for anterior support (Fig. 6).
(A) CT scan coronal reconstruction showing recurrence of paravertebral empyema. (B) Intraoperative image following posterior debridement.
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Concurrently, a newly resurged septated empyema had developed in the paravertebral space, which demanded for a combined anterior and posterior approach, for complete drainage (Fig. 7).
Current patient status.
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Currently, after 9 months from the initial surgery, the patient remains stable and asymptomatic with no evidence of infection or tumor relapse (Fig. 8).
CT scan with no evidence of tumor relapse or instrumentation failure.
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The follow-up imaging studies show encouraging evolution without bone graft resorption or failure of the instrumentation (Fig. 9).