PMC6421778_01
Preoperative thoracolumbar spine radiographs in the supine (a, b) and sitting (c) positions, showing intravertebral vacuum cleft (long arrows), extravertebral gas (short arrow), and the fracture line of T10 extending to posterior fusion mass bone (arrow head) grafted 8 years ago.
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fig1
Preoperative coronal (a) and axial (b) computed tomographies of the thoracic spine obtained in the supine position, more clearly showing the gas and fluid collections (arrows) just below the left 10th rib head in (a) and the T10-T11 extraforaminal zone in (b).
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fig2
T10 collapsed vertebral wall ipsilateral to the side of her chest pain. The computed tomography (CT) scans, which have a higher sensitivity in detecting gas than radiography and magnetic resonance imaging (MRI) scans, more clearly showed an accumulation of gas located just below the head of the left 10th rib, the place radiologically termed the T10-T11 extraforaminal zone (Figure 2).
Preoperative axial T1-weighted (a) and T2-weighted (b) magnetic resonance imaging, showing the gas (long arrows pointing T1-low and T2-low signal intensity areas) and fluid (short arrows pointing T1-iso and T2-high signal intensity areas) collections just below the left 10th rib head.
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fig3
Corresponding to the extravertebral area of radiolucency shown by the AP radiograph and the CT, both T1- and T2-weighted axial MRI showed combined gas-like and fluid-like signal intensities; i.e., a gas-like low signal intensity area with a fluid-like iso-signal intensity area on the T1-weighted image and a gas-like low signal intensity area with a fluid-like high signal intensity area on the T2-weighted image (Figure 3).
Anteroposterior (a) and lateral (b) radiographs of the thoracolumbar spine at the 2-year follow-up after surgery, showing posterior spinal fusion from T7 to L2 with pedicle screw instrumentation performed for the T10 osteoporotic vertebral fracture involving three columns.
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fig4
Because of the unstable nature of the fracture involving all structural components from anterior through posterior spinal columns, in addition to her persistent disabling pain not responding to conservative therapy, we carried out posterior spinal fusion from T7 to L2 with pedicle screw instrumentation followed by iliac bone graft (Figure 4).