PMC9837236_01
Lumbar MRI on sagittal planes taken immediately after the trauma and 8 months later. The integrity and connectivity of the vertebra following the initial trauma are not interrupted, and the marrow signal is even. (A-C, arrows) After asymptomatic 8 months, the pain is onset again, all MRI sequences show the wedge-shaped changes of T11 vertebra, and the abnormally confined hypointensity area underneath the upper endplate (D-F, arrowheads), indicating the formation of IVC. 
T1WI
 T1-weighted image, 
T2WI
 T2-weighted image, 
STIR
 short-tau inversion recovery
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Lumbar MRI demonstrated all the vertebral integrity or connectivity was not interrupted, and the marrow signal was even (Figure 1). Abnormally confined hypointensity area underneath the upper endplate was detected on all sagittal lumbar MRI sequences (Discovery MR750, General Electric, Milwaukee, WI, USA) of the T11 vertebra, including sagittal T1-, T2-weighted, and short-tau inversion recovery (STIR) images, indicating IVC formation (Figure 1).
Sagittal lumbar CT image analyzed by ImageJ. The original image of the T11 vertebra (A, arrow) analyzed by ImageJ with a CT value of -1000 HU indicates the IVC filled with gas (B, red color area) in the T11 vertebra (yellow outline). The same original image analyzed by ImageJ with a CT value of 300-1000 HU shows no continuous mineralized callus formation (C, green color area) inside or outside of the IVC, indicating the IVC nonunion. 
HU
 Hounsfield Unit, 
IVC
 intravertebral vacuum cleft
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The sagittal CT images were analyzed using ImageJ (Wayne Rasband National Institutes of Health, USA, Java1.8.0_112 [64-bit], https://imagej.nih.gov/ij/) with a CT value of -1000 Hounsfield Unit (HU) and 300-1000 HU, showing the IVC with gas collection but no continuous mineralized call us formation (Figure 2).
Lateral view of spinal X-rays centered on T11 vertebra pre-and post-operation on 3 days. The pre-operation X-rays indicate the IVC (A, arrowheads) within the wedge-shaped changes of T11 vertebra (A, arrow). The post-operation X-rays (B, arrow) show the restoration of T11 vertebral height, filling with bone cement without leakage. 
IVC
 intravertebral vacuum cleft
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T11 vertebra filled with bone cement without leakage (Figure 3). Three months and one year after discharge, the patient was ambulated with no pain and performed portions of her housework.