PMC6015715_01
Preoperative magnetic resonance imaging (MRI) of the lumbar spine. (a) Midsagittal T1-weighted and (b) short tau inversion and recovery (STIR) MRI showing the L2 vertebral fracture and disruption of the posterior ligamentous complex between L1 and L2 in combination with extensive subcutaneous hematoma.
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Magnetic resonance imaging (MRI) of the spine also demonstrated an L2 vertebral fracture and disruptions of the posterior ligamentous complex between L1 and L2, in combination with extensive subcutaneous hematoma (Figure 1).
Preoperative computed tomography (CT) of the lumbar spine. (a) Left parasagittal CT showing an L2 fracture involving the vertebral body and extending through the pedicle posteriorly. (b) 3D-CTs from the left lateral view and (c) posterior view show that the fracture consists of horizontal splitting from the vertebra, through the left pedicle and transverse process, and reaching to the mid-upper neural arch.
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Computed tomography (CT) of the spine in the sagittal orientation and 3-dimensional (3D) CT further revealed the involvement of the superior end plate of the L2 vertebra, comprising horizontal splitting from the left pedicle, through the left transverse process, and reaching the center of the neural arch (Figure 2).
Postoperative plain X-rays of the lumbar spine. (a) Anteroposterior and (b) lateral radiographs show an L1-L2 single-level instrumented fusion using a CBT pedicle screw for L2 on the left side.
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Postoperative X-rays showed good reduction by this single-level fixation (Figure 3).
Postoperative computed tomography (CT) of the lumbar spine. (a) Left parasagittal CT obtained 6 months after surgery showing good reduction and fracture healing of the L2 vertebral body and pedicle, with proper CBT screw placement. (b, f) 3D-CTs obtained 1 year after surgery from the left anterolateral view, (c, g) left lateral view, (d, h) left posterolateral view, and (e, i) posterior view showing the screw trajectories in 3D view and complete bone union of the fracture, including the L2 vertebral body, pedicle, and transverse process. (f-i) Bone density was reduced to observe screw trajectories.
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Sagittal CT and 3D-CT obtained at 6 months and 1 year postoperatively showed proper trajectory of the CBT pedicle screw and complete bone union (Figure 4).