PMC7305354_01
Preoperative radiographs of a 68-year-old female patient with OVF.. Preoperative radiographs of a 68-year-old female showing kyphoscoliotic deformity at the thoracolumbar spine associated with non-union of OVF at L1. (a) Standing whole-spinopelvic AP radiograph, (b) Standing whole-spinopelvic lateral radiograph, (c) Lumbar AP radiograph, (d) Lumbar lateral radiograph in flexion, and (e) Lumbar lateral radiograph in extension.
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Her radiographs showed non-union at L1, kyphotic deformity of the thoracolumbar spine, and sagittal imbalance (Fig. 1a-e).
MRI and CT myelogram of the thoracolumbar spine.. Views: (a) MRI of T2-weighted sagittal image, (b) MRI of T2-weighted axial image at L1, and (c) Sagittal image reconstruction of CT myelogram.
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Magnetic resonance imaging (MRI) of the lumbar spine showed a collapsed L1 vertebral body, and the posterior bone fragment compressing the spinal cord with bending motion (Fig. 2a,b). Her computed tomography (CT) myelogram showed an intravertebral vacuum cleft sign and destructive change of the L1 vertebral body (Fig. 2c).
Clinical appearance of the patient with OVF who had a history of systemic scleroderma.. The patient had a history of systemic scleroderma, which was complicated by interstitial lung disease. (a,b) Her fingers and toes were cold due to Raynaud's phenomenon of systemic scleroderma. (c) Pressure sores were observed around the prominent L1 spinous process.
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Her fingers and toes were cold due to Raynaud's phenomenon of systemic scleroderma (Fig. 3a,b), and pressure sores were observed around the prominent L1 spinous process (Fig. 3c).
Intraoperative images.. Minimally invasive technique of vertebroplasty with posterior spinal fusion combined with PPS, sublaminar polyethylene taping, and computer-assisted rod contouring was performed for OVF at L1. (a) Jamshidi needles were placed through lumbodorsal fascia, and the PPSs were placed at Th11 and L3 through guide wires under fluoroscopic guidance. (b) Each location for the screw heads were registered by the Bendini  Digitizer. (c-f) The Bendini  software enabled the estimation of rod lengths and visualization of the ideal rod contours; (c) Coronal rod contour on the left, (d) Sagittal rod contour on the left, (e) Coronal rod contour on the right, (f) Sagittal rod contour on the right. (g) A rod was placed into the multi-axial rod bender and was bent according to the instructions of the Bendini  software. (h) Sublaminar polyethylene tapes were tightened to the rods. (i) Postoperative surgical wound.
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Given her condition, a vertebroplasty with posterior spinal fusion was performed using PPS at UIV and LIV combined with sublaminar polyethylene taping and in-situ fusion using a computer-assisted rod contouring system (Bendini ; NuVasive, Inc., San Diego, CA) (Fig. 4a-i). The PPSs were placed at Th11 and L3 after tapping the pedicle holes through the guide wires (Fig. 4a). After the placement of pedicle screws, each location for the screw heads were registered by the Bendini  Digitizer (Fig. 4b). The Bendini  software enabled us to estimate the rod lengths and to identify the ideal rod contours (Fig. 4c-f). A rod was placed into the multi-axial rod bender (Fig. 4g) and was bent according to the instructions of the Bendini  software. Sublaminar polyethylene tapes were tightened to the rods (Fig. 4h). Her surgical wound healed well without any wound dehiscence (Fig. 4i).
Postoperative radiographs and CT images at 1-year postoperatively.. One-year postoperative radiographs: (a) Standing whole spinopelvic AP radiograph, (b) Standing whole-spinopelvic lateral radiograph, (c) Lumbar AP radiograph, (d) Lumbar lateral radiograph. (e) Sagittal image reconstruction of CT images at 1-year postoperatively.
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Local kyphosis and sagittal imbalance were markedly restored; lumbar lordosis was 33 , local kyphosis was 14 , and sagittal vertical axis was 6.8 cm on her postoperative radiograph (Fig. 5a-d). Her postoperative CT showed good bony union without screw loosening or screw pull-out 1-year postoperatively (Fig. 5e).