PMC6698561_01
Preoperative computed tomography (CT) images of the patient in Case 1.. Axial view of L1 [A], L2 [B], L4 [D], L5 [E], and sacrum [F, G], sagittal view of thoracolumbar [C], lumbosacral [H], and 3D reconstruction images of the pelvis [I]. There were burst fractures of L1 and L2 [A-C], and the right transverse process fracture of L4 [D, I], the left transverse process fracture of L5 [E, I], and H-shaped sacral unstable fracture [F-I].
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We diagnosed these burst fractures as AO classification type A3 (Fig. 2A-C). We diagnosed these pelvic fractures as AO classification type C3 (Fig. 2D-I).
Postoperative X-ray images and CT of the patient in Case 1.. AP view [A], lateral view [B] of the X-ray image at the time after surgery and AP view of X-ray image [C], sagittal CT view of spine [D], and axial CT view of sacrum [E] at final follow-up (one year after surgery). T12 to L3 instrumented posterior spinal fusion with PPS for L1 and L2 burst fracture, and L4 to ilium instrumented posterior spinopelvic fixation with L4 and L5 PPS and mini-open iliac screws for unstable sacral fracture were performed [A, B]. One year after surgery at the final follow-up, radiographic findings revealed almost healed L1 and L2 fractures, and an unstable sacral fracture [C-E].
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T12 to L3 instrumented posterior spinal fusion with PPS for L1 and L2 burst fracture, and also L4 to ilium instrumented posterior spinopelvic fixation with L4 and L5 PPS and mini-open iliac screws for unstable sacral fracture as described above (Fig. 3A, B). The operative time was 2 h 15 min, and the blood loss was 100 mL. X-ray imaging and CT at the final follow-up revealed almost healed L1 and L2 fractures, and an unstable sacral fracture (Fig. 3C-E).
PMC6698561_02
Radiographic findings in Cases 2 and 3.. Case 2: Preoperative CT sagittal view [A] and 3D reconstructed images of the pelvis [B] showing an L1 burst fracture, right transverse process fracture of L4, bilateral transverse process fracture of L5, and unstable H-shaped sacral fracture. Postoperative AP X-ray image [C] and lateral X-ray image [D]. T12 to L2 instrumented posterior spinal fusion with PPS for L1 burst fracture, and L4 to ilium instrumented posterior spinopelvic fixation with the mini-open Galveston approach for unstable sacral fracture. Postoperative sagittal CT view of the spine [E] and axial CT view of the sacrum [F] at final follow-up (one year after surgery). The CT view of the spine shows an almost healed L1 fracture, but the CT view of the sacrum reveals a delayed union.. Case 3: Preoperative CT sagittal view [G] and 3D reconstructed images of the pelvis [H] showing L1, L3, and L4 burst fractures, bilateral transverse process fractures of L5, and an unstable H-shaped sacral fracture. Postoperative AP view [I] and lateral view [J] of X-ray images. T11 to ilium instrumented posterior spinopelvic fixation with PPS and mini-open Galveston approach for L1, L3, and L4 burst fractures, and the unstable sacral fracture. Postoperative sagittal CT view of the spine [K] and axial CT view of the sacrum [L] at final follow-up (one year after surgery) shows almost complete healing.
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CT revealed that there were L1, L3, and L4 burst fractures, bilateral transverse process fractures of L5, and an unstable H-shaped sacral fracture (Fig. 4E, F). T11 PPS to iliac screws using a single rod, because there were also L3 and L4 burst fractures (Fig. 4G, H).
PMC6698561_03
Radiographic findings in Cases 2 and 3.. Case 2: Preoperative CT sagittal view [A] and 3D reconstructed images of the pelvis [B] showing an L1 burst fracture, right transverse process fracture of L4, bilateral transverse process fracture of L5, and unstable H-shaped sacral fracture. Postoperative AP X-ray image [C] and lateral X-ray image [D]. T12 to L2 instrumented posterior spinal fusion with PPS for L1 burst fracture, and L4 to ilium instrumented posterior spinopelvic fixation with the mini-open Galveston approach for unstable sacral fracture. Postoperative sagittal CT view of the spine [E] and axial CT view of the sacrum [F] at final follow-up (one year after surgery). The CT view of the spine shows an almost healed L1 fracture, but the CT view of the sacrum reveals a delayed union.. Case 3: Preoperative CT sagittal view [G] and 3D reconstructed images of the pelvis [H] showing L1, L3, and L4 burst fractures, bilateral transverse process fractures of L5, and an unstable H-shaped sacral fracture. Postoperative AP view [I] and lateral view [J] of X-ray images. T11 to ilium instrumented posterior spinopelvic fixation with PPS and mini-open Galveston approach for L1, L3, and L4 burst fractures, and the unstable sacral fracture. Postoperative sagittal CT view of the spine [K] and axial CT view of the sacrum [L] at final follow-up (one year after surgery) shows almost complete healing.
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CT revealed that there were L1, L3, and L4 burst fractures, bilateral transverse process fractures of L5, and an unstable H-shaped sacral fracture (Fig. 4E, F). T11 PPS to iliac screws using a single rod, because there were also L3 and L4 burst fractures (Fig. 4G, H).