PMC3228380_01
(a) Sagittal and (b) axial MRI of the lumbosacral spine revealed L1-L2 spondylodiscitis/osteomyelitis with a small, noncompressive anterior epidural collection and bilateral psoas muscle abscesses
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F1
Computed Tomography (CT) and magnetic resonance imaging (MRI) of the lumbosacral spine revealed L1-L2 spondylodiscitis with a small, noncompressive anterior epidural collection and bilateral psoas muscle abscesses [Figure 1].
(a) Sagittal CT reconstructions of the lumbosacral spine demonstrate an extensive lytic process involving the L1 and L2 vertebral bodies. There is a significant involvement and narrowing of the L1-L2 disc space with endplate erosion. (b)-(d) MRI of the lumbar spine confirms CT findings and suggests L1-L2 spondylodiscitis. In addition, there is a progression of a large enhancing anterior epidural collection, which is compressing the thecal sac at L1-L2 and bilateral psoas muscle abscesses are demonstrated.
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F2
Repeat CT and MRI [Figure 2] revealed progression of the spondylodiscitis with marked expansion of the anterior epidural abscess and compression of the cauda equina.
(a, b) Intraoperative photographs demonstrate the two-stage surgical procedure: L1 and L2 corpectomies with femoral strut grafting and T12-L3 instrumented fusion through a left thoracoabdominal approach (a), followed by minimally invasive T11-L4 posterior instrumentation using percutaneously placed pedicle screws (b). (c,d) Postoperative radiographs of the lumbosacral spine
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F3
Through an anterior thoracoabdominal approach, L1 and L2 corpectomies with extensive debridement were performed, followed by T12-L3 instrumented fusion using a cadaveric femoral strut allograft [Figure 3a]. Following this first stage, a minimally invasive posterior T11-L4 instrumentation using percutaneously placed pedicle screws was performed to supplement the ventral construct [Figure 3b]. Radiographic imaging demonstrated satisfactory alignment [Figures 3c and 3d].