PMC8247937_01
Annual MR imaging of the thoracic spine over 3 years (a-c) demonstrates stability of the increased signal intensity of the T2-T6 vertebral bodies, which is consistent with the fatty marrow replacement seen in Gorham-Stout disease. Postinjury imaging (d) demonstrates severe kyphosis at T3-T4. Acute cord signal change is evident, in keeping with acute myelopathy (d).
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F1
Previously, serial MR studies showed asymptomatic progressive fatty marrow replacement of the T4-T6 spinous processes and T2-T6 vertebral bodies/posterior elements; nothing had changed over 3 years [Figure 1a-c]. The MR showed spinal canal stenosis at T3-T4 with hyperintense signal in the cord on T2 sequences [Figure 1d]. The CT demonstrated a fracture of the T3 inferior endplate and T4 superior endplate with extension through the right superior facet and left inferior facet resulting in destruction of the posterior elements and 53  of kyphosis with levoscoliosis [Figure 2a and b].
CT imaging shows the T3 spinous fracture (a) sustained 1 month before further pathologic kyphotic angulation deformity at T3-T4 with extensive destruction of the posterior elements (b). Postoperative CT imaging demonstrates instrumented fusion from T1-T10 with significant improvement in kyphotic deformity at T3-4 (c).
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F2
The MR showed spinal canal stenosis at T3-T4 with hyperintense signal in the cord on T2 sequences [Figure 1d]. The CT demonstrated a fracture of the T3 inferior endplate and T4 superior endplate with extension through the right superior facet and left inferior facet resulting in destruction of the posterior elements and 53  of kyphosis with levoscoliosis [Figure 2a and b]. T4 and posterior instrumented fusion from T1 to T10 [Figure 2c]. The right T4 nerve root was sacrificed during the vertebrectomy, and a traumatic dural laceration sustained as a result of the fracture was repaired with an autologous duraplasty. The patient made an uneventful recovery, except for a persisting left pleural effusion, a known complication of GSD that was present preoperatively and unrelated to surgical intervention.