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A preoperative lumbosacral MRI showed a L3 involvement by lymphomatous tissue with evidence of intracanalar diffusion as indicated by arrow (A). A postoperative MRI with evidence of surgical procedure of decompressive laminectomy and stabilization with titanium pedicle screws (see arrow) and rods (B).
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Two days later, a surgical procedure of posterior lumbar stabilization with titanium pedicle screws (located at L2 and L4) and rods associated with a decompressive laminectomy was performed, in addition to a biopsy (Fig. 1).
Preoperative lumbar CT-scan (A) and MRI (B) showed the proximity of migrated rod to the foramen of the exit of the left S1 root and the intensive inflammatory reaction of the surrounding bone, each indicated by arrows.
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The left one was distally migrated to the pre-sacral region adjacent to the sacral foramen of the exit of the S1 root (Fig. 2) and the right one was positioned on the upper level of the second lumbar vertebral body (Figs. 2 and 3).
AP and LL lumbar x-ray performed after an S1 left radiculopathy onset showed the migration of both paravertebral rods, with the left one migrated in the pre-sacral region and the right one positioned at the upper level of second lumbar vertebral body (A and B). A coronal and sagittal plane of preoperative MRI allowed the visualization of the bone sacral groove created by the migrated left rod as marked by arrows (C and D).
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A critical retrospective analysis of a previous MRI demonstrated that, in some slices, the migration had already been evident (Fig. 3).
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Lumbar preoperative CT scan with evidence of bone formation around the migrated rods probably due to micro movements (A and B). The arrows show the strong bone reaction that during the second surgical procedure needed bone drilling to grant rods removal (C and D).
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There was no hardware replacement because of the posterolateral arthrodesis process was adequate and complete (Figs. 4 and 5).
Postoperative lumbar MRI (A) and LL X-ray (B) with evidence of screws and rods removal, and L3 vertebroplasty (see arrow) with preservation of spine stability.
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The postoperative neuroimaging control (lumbar dynamic X-ray and MRI) showed no complications, while confirming the L3 vertebroplasty without any sign of spinal instability (Fig. 5).
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Postoperative lumbar MRI (A) and LL X-ray (B) with evidence of screws and rods removal, and L3 vertebroplasty (see arrow) with preservation of spine stability.
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The postoperative neuroimaging control (lumbar dynamic X-ray and MRI) showed no complications, while confirming the L3 vertebroplasty without any sign of spinal instability (Fig. 5).