case_images: PMC10783691_01
case_images: (a) Sagittal gadolinium-enhanced T1-weighted magnetic resonance imaging (MRI) showing an extradural enhancing metastatic tumor at L2-3. (b) Axial MRI at L2-3 revealed severe spinal stenosis and tumor invasion of both L2/3 facet joints. (c) Axial MRI revealing tumor invasion of the left L3/4 facet.
case_images: SNI-14-439-g001.jpg
case_images: PMC10783691_01_SNI-14-439-g001.jpg
case_images: F1
case_images: The lumbar magnetic resonance imaging revealed an extradural compressive enhancing mass at the L2-3 level and invasions of the bilateral L2/3 and left L3/4 facets [Figure 1].
case_images: (a) Axial computed tomography (CT) of L2-3 demonstrating osteolytic changes involving bilateral pedicles and part of the L2/3 facets. (b) Axial CT showing the destruction of the left L3/4 facet. (c) Sagittal L2-L3 CT image showing subluxation (arrow). (d) Sagittal CT image identifying further progression of subluxation one month later than (c) (arrow).
case_images: SNI-14-439-g002.jpg
case_images: PMC10783691_01_SNI-14-439-g002.jpg
case_images: F2
case_images: The lumbar computed tomography showed L3 dorsal osteolytic changes involving the left pedicle with L2-L3 subluxation [Figure 2].
case_images: (a) AP X-ray at five months post-surgery revealing dislodgement of the bilateral set screws of the S2 alar-iliac screw (S2AIS) (arrow). (b) Oblique X-ray 12 months after the second surgery showing the repeated dislodgement of the right set screw of the S2AIS (arrow). (c) AP X-ray at the final follow-up showed the stability of the fusion with the S2AIS and iliac screws (arrow).
case_images: SNI-14-439-g003.jpg
case_images: PMC10783691_01_SNI-14-439-g003.jpg
case_images: F3
case_images: Although asymptomatic, radiographic assessment five months postoperatively revealed dislodgement of the bilateral set screws of the S2AIS [Figure 3a]. However, one year later, the right set screw dislodged [Figure 3b]. A third surgery confirmed that the right set screw had slipped out and the left set screw had loosened; therefore, the right S2AIS was replaced, and additional bilateral iliac screws were placed once the transverse connector had been removed [Figure 3c].