PMC3192513_01
(Left) sagittal T2 MRI showing fracture subluxation at L1 and the anterior displacement of the neural elements, arrow points to the dorsally located extradural meningeal cyst; (right) sagittal CT revealing the burst fracture with subluxation at L1
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F1
The CT scan revealed an L1 burst fracture with subluxation and bilateral pedicle fractures at L1 and L2 [Figures 1 and 2]. Subsequent advanced imaging with MRI revealed the presence of an extradural meningeal cyst [Figures 1 and 2].
(Top) axial CT and T2 MRI at the level of L1 showing bilateral pedicle fractures and subluxation associated with canal compromise. (Middle) axial CT and T2 MRI at the level of L2 showing bilateral pedicle fractures and a dorsally located extradural meningeal cyst. (Bottom) axial CT and T2 MRI at the level of L3 showing aberrantly thin pedicles, anterior displacement of the neural elements, and dorsally located extradural meningeal cyst
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F2
The CT scan revealed an L1 burst fracture with subluxation and bilateral pedicle fractures at L1 and L2 [Figures 1 and 2]. The patient was noted to have asymmetrically and atypically thin pedicles at these levels [Figure 2]. Subsequent advanced imaging with MRI revealed the presence of an extradural meningeal cyst [Figures 1 and 2].
Intraoperative photo showing an extradural meningeal cyst (double arrow) dissected away from the dura of the thecal sac (single arrow)
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F3
The meningeal cyst was resected and the ostium of the meningeal cyst was found in the axilla of the L3 nerve root near the thecal sac [Figures 3 and 4].
Intraoperative photo showing the emptied extradural meningeal cyst resected (broken arrow) and cyst ostium (double arrow) of the thecal sac (single arrow) laterally
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F4
The meningeal cyst was resected and the ostium of the meningeal cyst was found in the axilla of the L3 nerve root near the thecal sac [Figures 3 and 4].
Postoperative AP and lateral X-rays showing good alignment, reduction of the subluxation, and instrumentation
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F5
Radiographically, postoperative x-rays and a CT demonstrated excellent alignment and placement of pedicle screw instrumentation [Figure 5].