PMC9899349_01
Preoperative radiological findings.. The images show (A) radiological findings at the injury. T12 vertebral fracture was not diagnosed by x-ray (left) or CT (center), but by MRI (right). Ossification by DISH was observed between the thoracic segments and L4 (triangle). (B) Radiological findings after one year from the injury. X-rays showed inter-vertebral instability of T12 between the standing position (upper left) and the supine position (upper center). MRI showed a fluid collection at T12 (upper left, white arrow). CT images showed an anterior huge intervertebral cleft and transverse lamina fracture at T12 (black arrow).. DISH: diffuse idiopathic skeletal hyperostosis; CT: computed tomography; MRI: magnetic resonance imaging
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FIG1
T12 vertebral fracture was not diagnosed by the initial radiological examinations, x-rays and computed tomography (CT), but was diagnosed by magnetic resonance imaging (MRI) (Figure 1A). However, his low back pain had prolonged, and the T12 vertebral fracture developed non-union one year after the injury (Figure 1B).
Postoperative x-rays of the patient.. The images show (A) kyphoplasty at T12 and T10-L2 posterior fixation using PES was performed by the percutaneous technique. (B) Pneumothorax at the left side could be observed in the postoperative radiograph by adjusting the window level to the lung condition..  PES: penetrating endplate screw
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FIG2
T12 kyphoplasty and T10-L2 posterior fixation using the PES technique (VBS and EXPEDIUM VERSE; DePuy Synthes Spine, Inc., Raynham, MA) was performed percutaneously under single fluoroscopy without the navigation system (Figure 2A). After confirmation of postoperative x-ray by the attending spine surgeons who had 10- and five-year experience in spine surgery (Figure 2A), the anesthesiologist extubated and the patient returned to the normal ward. None of the surgeons or the anesthesiologist recognized pneumothorax in the operating room, although pneumothorax could be detected retrospectively from the postoperative x-ray by adjusting the window level to the lung condition (Figure 2B).
Radiological findings two days after surgery.. Pneumothorax on the left side was observed in the chest x-ray (A) and the chest CT (B). Postoperative spine CT (C) showed that the left screw at T10 was placed lateral to the pedicle but caught vertebral body (arrow). The rib head at left T10 displaced to the anterior compared with the right side (circle).. CT: computed tomography
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FIG3
CT (Figure 3B). CT also showed that the left side T10 screw was set laterally to the pedicle but caught the vertebral body (Figure 3C). There was no deviation of the screw to the thorax. The rib head of the left T10 was laterally and anteriorly displaced (Figure 3C, circle).