PMC5934969_01
Computed tomography scan images with preoperative sagittal reconstruction (a) showing the significant retropulsion of the posterior wall with a significant split and around 50% reduction in height of the fractured vertebra with concomitant regional kyphosis. Preoperative axial view (b) showing the severe canal narrowing and rupture of the posterior wall which makes this a type A4 fracture. Postoperative sagittal view (c) showing the restoration of height of the fractured vertebra, reversal of the kyphosis and good reapproximation of the fragments causing the split. Axial view (d) showing a good enlargement of the central canal diameter
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F1
The spinal canal was severely stenosed just below the level of the conus [Figures 1a and b-2a and b]. A postoperative CT scan of the instrumented segment confirmed an important widening of the central canal and reversal of kyphosis [Figure 1c and d].
Preoperative magnetic resonance imaging in sagittal and axial view (a and b) showing the severe narrowing and compression of the neural structures. Postoperative X-ray (c) illustrating the sagittal alignment and implant positioning
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F2
The spinal canal was severely stenosed just below the level of the conus [Figures 1a and b-2a and b]. Rx rays of the lumbar spine after 3 months show good maintenance of the sagittal alignment [Figure 2c].
Photograph illustrating patient positioning and the maneuver of on-table-traction (a). Fluoroscopy images showing both pre-and post-traction images with the respective realignment (b and c)
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F3
Two operators would now hold the patient at both ankles and under the armpits and apply simultaneous traction in the craniocaudal directions [Figure 3a]. With this maneuver a good reduction of the segment was obtained, and realignment of the posterior wall of the fractured vertebra was already clearly visible on fluoroscopy [Figure 3b and c].