PMC10159301_01
X-ray on standing (a) and decubitus position (b) revealed compression fracture at Th 12 with remarkable intravertebral vacuum cleft, which was the lowermost part of diffuse idiopathic skeletal hyperostosis.
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F1
Standing/decubitus dynamic X-rays revealed a vertebral compression fracture at T12 level accompanied by an intravertebral vacuum cleft (i.e., the lower-most level of diffuse idiopathic skeletal hyperostosis [DISH]) [Figure 1].
Balloon was expanded until either appropriate reduction or complete balloon expansion within the vertebral body. The stents were deployed through inflation of the balloon inside the vertebral body, confirming the stability between the endplate and stent (a and b). However, the right side stent toppled over just after removing balloon catheter and it was difficult to inject the cement into the toppled stent (c and d).
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F2
Inflation catheters were inserted and balloons were expanded until appropriate reduction and/or complete balloon expansion had occurred within the T12 vertebral (i.e., inflation of balloons inside the vertebral body) [Figures 2a and b]. However, the right-sided stent "toppled over" just after removing the balloon catheter, making it impossible to inject an adequate volume (i.e., and to retain) an adequate volume of cement [Figures 2c and d].
Vertebral body stenting system and additional posterior fixation was performed at the three levels spanning from Th10 to L1 because the pedicles above Th11 and below L2 were too narrow to insert screws. The stent edge directed toward ventral side (a and b). Bony fusion to Th11 covering beaked stent was achieved and pedicle screws were removed 1 year after operation (c and d).
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F3
Therefore, an additional posterior fixation procedure from Th10 to L1 was warranted (i.e., bony fusion to Th11 covered the beaked stent) [Figures 3a and b]. Pedicle screws were removed 1 year postoperatively [Figures 3c and d].