PMC8053452_01
Preoperative radiographs (a and b) and CT (c-e) scan showing destruction of T12 and L1 vertebral bodies with complete collapse of T12 and partial collapse of L1 body. Preoperative MRI showing signal intensity changes in T11, T12, and L1 vertebrae with hyperintense signal on T2 imaging (f-j) and hypointense signal on T1 imaging (g). Blue arrows depict the pathology.
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F1
Thoracolumbar radiographs (AP/Lateral) and CT scan suggested huge lytic lesions with complete destruction of T12 and L1 vertebral body as well as pedicles and posterior elements and complete collapse of body of T12 with partial collapse of the body of L1 [Figure 1]. MRI suggested abnormal marrow signal intensity lesion involving vertebral body and posterior elements with pathological collapse of T12 with similar signal intensity changes in T11 and L1 bodies [Figure 1]. T9-L2, likely to be prominent epidural blood vessels [Figure 1]. The primary differential diagnoses were spinal tuberculosis and neoplastic etiologies.
Digital subtraction angiography images of the patient showing predominant feeding vessels of the right T12 pedicle (a and b) and intra-procedural images (b) showing embolization of the feeder vessels. Blue arrows show the catheter used for embolization.
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F2
DSA was performed after 2 months of surgery through the right femoral artery which revealed EDAVFs fed by the vessels arising from T10-L2 vertebrae and transcatheter embolization of the predominant right T12 feeders was performed with 25% glue (2 ml) [Figure 2]. DSA performed after the embolization revealed 30 % reduction of fistula fed by vessels from the right T12 pedicle [Figure 2].
Follow-up radiographs (a and b) showing a stable construct and postoperative MRI (c-e) showing decompression of the spinal cord.
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F3
At follow-up after 21 months of surgery, the patient is free from pain, walking independently with normal neurological examination findings [Figure 3].