PMC9091407_01
Pre-operative radiograms. (a) Anteroposterior radiogram of the whole spine. No scoliosis was present. (b) Lateral radiogram of the whole spine showing a posterior shift of the sagittal alignment.
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F1
The anteroposterior (AP) radiogram of the whole spine revealed no obvious scoliosis, with bone maturity of Risser Grade 4 (Fig. 1a). The lateral radiogram of the whole spine showed hypoplasia of the anterior portion of the L2 vertebral body with a sagittal vertical axis (SVA) of -60 mm (Fig. 1b). The spinal parameters measured in the lateral radiogram were as follows: Thoracic kyphosis (TK) at T5-12, 17 ; local kyphosis at L1-3, 23 ; lumbar lordosis (LL) at L1-S1, 38 ; LL at L3-S1, 59 ; and pelvic incidence (PI), 34  (Fig. 1b).
Pre-operative dynamic lateral radiograms of the lumbar spine. (a) Extended position. (b) Flexed position. The local kyphosis at L1-3 was 23  and 44 , respectively. The facet joints at L2-3 were subluxated (circled).
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F2
In the dynamic lateral radiograms, local kyphosis at L1-3 was 23  in the extended position (Fig. 2a) and 44  in the flexed position (Fig. 2b). In addition, the facet joints at the L2-3 spinal level were subluxated in the flexed position (Fig. 2b).
Pre-operative computed tomography scans. (A) Axial view. (B) Three-dimensional computed tomography. Symmetrical hypoplasia of the anterior portion of the vertebral body of L2 was shown.
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F3
Computed tomography showed symmetrical hypoplasia of the anterior portion of the vertebral body of L2 (Fig. 3).
Radiograms and computed tomography scans performed 2 years postoperatively. (a) Anteroposterior and (b) lateral views of the whole spine radiogram. (c) Sagittal view of computed tomography scans. Bone union at L1-2 was confirmed.
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F4
A whole-spine AP radiogram at 2-year post-operative follow-up revealed no obvious scoliosis (Fig. 4a). The lateral radiogram demonstrated that SVA improved to 9 mm, TK to 35 , local kyphosis at L1-3 to -2 , LL to 40 , and LL at L3-S1 to 34  (Fig. 4b). In addition, bone union was confirmed at L1-2 vertebral bodies by computed tomography (Fig. 4c).