PMC3835208_01
(a) Length in the standing position and lateral image in the standing position. (b) CT-MPR of the total length of the spine. The lateral X-ray image in the standing position showed no L2-L3 intervertebral space, but CT-multiplanar reconstruction images in the dorsal position showed a clearly opened L2-L3 intervertebral space.
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fig1
Radiographs of the thoracic and lumbar spine showed flowing ossification along the anterior and lateral aspects of the Th2-L5 vertebral bodies, with disruption of ossific ridging and marked destructive changes at the L2-L3 intervertebral disc level (Figure 1).
(a) Flexion and (b) extension images of the spine, showing instability at the L2-L3 intervertebral space and a stenosis of spinal canal is observed in the extension position.
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fig2
Myelography showed stenosis at the L2-L3 intervertebral space and flexion-extension radiograph indicated instability at this position (Figure 2).
Lateral plain X-ray image obtained after the first surgery. In addition to posterior fusion at the L1-L5 intervertebral space, posterior lumbar interbody fusion at the L2-L3 intervertebral space was performed using a PEEK cage and local bone.
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fig3
We performed posterior fusion from the L1 to L5 levels with spinal instrumentation, in addition to posterior lumbar interbody fusion at the L2-L3 intervertebral space (Figure 3).
Lateral plain X-ray image obtained 10 weeks after the first surgery, showing loosening and back-out of the pedicle screw at L1-L2.
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fig4
Thus, a second surgery was performed 12 weeks after the initial surgery (Figure 4).
(a) Frontal and (b) lateral images obtained at 18 months after the second surgery, showing no loosening of pedicle screws and favorable bone adhesion in PLIF and PLF.
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fig5
Plain radiographs taken 1.5 years after surgery showed rigid bony union at the L2-L3 intervertebral space (Figure 5).