PMC6744737_01
Case 1 - (a) Immediate postoperative fluoroscopic image of lumbosacral spine showing L2 wedge compression with pedicle screw at L1-L3 after primary surgery. (b and c) Anteroposterior/ lateral fluoroscopic image of lumbosacral spine at 1 year post instrumentation showing progressive L2 vertebral body collapse with pedicle screw loosening at L1 and L3.
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F1
For persistent increasing back pain, progressive pseudoarthrosis, vertebral body collapse, and focal kyphotic angulation, he required an MI lateral corpectomy [Figure 1: Case 1].
Case 1 - (a) Patient positioned in the right lateral decubitus position with the kidney bridge raised and table bent to provide access to the lumbar spine. (b and c) Localizing the target vertebrae on fluoroscopy and marking the safe zone to access the vertebrae. (d) Planned incision. (e) Lateral lumbar fluoroscopic image showing placement of the corpectomy cage and posterior pedicle screw fixation from D12 to L4.
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F2
This included partial resection of the 12th rib, placement of an interbody expandable cage, and revision of the posterior fusion using T12 to L4 percutaneous pedicle screw fixation [Figure 2: Case 1].
PMC6744737_02
(a-c) Case 2 - Preoperative sagittal, coronal, and axial magnetic resonance imaging of the lumbar spine revealed severe compression collapse fracture of the L3 vertebral body with T2 marrow hyperintensities and mild retropulsion of the fracture fragments with thecal sac compression.
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F3
The lumbar magnetic resonance imaging revealed 50% reduction in the L3 vertebral body height with dual-energy X-ray absorptiometry revealing osteopenia [Figure 3: Case 2 and Figure 4: Case 2].
(a-c) Case 2 - Lateral and anteroposterior lumbosacral fluoroscopic image showing compression fracture L3 with diffuse osteopenia.
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F4
The lumbar magnetic resonance imaging revealed 50% reduction in the L3 vertebral body height with dual-energy X-ray absorptiometry revealing osteopenia [Figure 3: Case 2 and Figure 4: Case 2].
Case 2 - (a and b) Lateral and anteroposterior fluoroscopic image showing expandable cage with pedicle screw at L2 and L4. (c) Postoperative radiograph of lumbosacral spine at 4 months (anteroposterior) showing placement of the corpectomy cage and posterior pedicle screw fixation from L2 to L4.
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F5
She underwent an L3 MI lateral corpectomy using an interbody expandable cage, supplemented with polymethyl methacrylate followed by percutaneous posterior pedicle screw fixation from L2 to L4 [Figure 5a and b: Case 2]. Follow-up X-rays confirmed adequate implant position and fusion across L2-L4 [Figure 5c: Case 2].