PMC4323509_01
Radiologic findings of the patient. A : An anterior-posterior X-ray of the lumbar spine showing the placement of the shape memory loop and the posterior lumbar interbody fusion at the level of L4/5. B : A lateral X-ray of the lumbar spine. C : A sagittal T2-weighted image showing the encroachment of the shape memory loop (arrow) on the dural sac in the upper lamina of L4 and the lower lamina of L5. D : An axial T2-weighted image at the upper lamina level of L4.
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F1
SML and no evidence of recurrent disc herniation or lateral stenosis (Fig. 1). She was referred to the authors for further evaluation and management.
A : A sagittal reconstruction view of the CT-myelogram showing subsidence of the shape memory loop (arrow). An axial view of the CT-myelogram at the level of L4 (B) and L5 (C).
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F2
On CT myelography, the upper and lower distal ends of the SML bilaterally were found to encroaching on the posterior dural sac (Fig. 2), and removal of the SMLs was planned to relieve the bilateral leg pain after receiving informed consent.
A : An intraoperative photograph showing the placement of the shape memory loop. B : An intraoperative photograph showing the status of the upper limb of the shape memory loop at the level of L4 (right side). C : Drilling of the shape memory loop with a diamond burr. D : A photograph showing the presence of an epidural hole (arrow) made from the previous placement of the limb of the shape memory loop, causing dural compression.
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F3
The adhesions along the SML were carefully divided and the SMLs were exposed (Fig. 3A, B). The SML could not be rotated or bent with several kinds of clamps, so the arms of the SML were drilled down with a diamond burr under microscopic vision (Fig. 3C). However, the upper ends that were hooked in the upper L4 laminae could not be extracted manually and additional drilling of the upper medial part of the laminae was needed to create rooms for the movement of the hooked SML ends (Fig. 3D). Upon removal of the ends of the SML, a small hole for the SML was noted (Fig. 3D).