case_images: PMC5352865_01
case_images: Preoperative radiography of the lumbar spine. Anteroposterior (AP) view (a); lateral view (b). Ossification of the yellow ligament (OYL) is seen at L3/4 and anterior spondylolisthesis of L4 vertebra, with concomitant ossification of the posterior longitudinal ligament.
case_images: CRIOR2017-3404319.001.jpg
case_images: PMC5352865_01_CRIOR2017-3404319.001.jpg
case_images: fig1
case_images: Plain radiography of the lumbar spine demonstrated OYL at L3/4 and anterior spondylolisthesis of L4 vertebra, with concomitant ossification of the posterior longitudinal ligament (OPLL) (Figure 1).
case_images: Preoperative magnetic resonance imaging. Sagittal T1-weighted image (a); sagittal T2-weighted image at the midspinal canal (b); axial T2-weighted image at the L3/4 level (c); axial T2-weighted image at the L4/5 level (d). Lumbar canal stenosis is seen at the L3/4 and L4/5 levels, with severe stenosis at L3/4.
case_images: CRIOR2017-3404319.002.jpg
case_images: PMC5352865_01_CRIOR2017-3404319.002.jpg
case_images: fig2
case_images: Magnetic resonance imaging showed lumbar canal stenosis at levels L3/4 and L4/5 and severe stenosis at L3/4 (Figure 2).
case_images: Preoperative computed tomography (CT) myelography. Sagittal image at the midspinal canal (a); axial image at the L3/4 level (b); axial image at the L4/5 level (c). OYL and complete block are seen at the L3/4 level.
case_images: CRIOR2017-3404319.003.jpg
case_images: PMC5352865_01_CRIOR2017-3404319.003.jpg
case_images: fig3
case_images: Computed tomography (CT) myelography revealed OYL and complete block at level L3/4 (Figure 3).
case_images: Postoperative radiography of the lumbar spine. AP view (a); lateral view (b). Lateral lumbar interbody fusion of L3/4 and L4/5 was performed at the initial surgery, and posterior decompression fixation using pedicle screws from L3 to L5 was performed at the second surgery.
case_images: CRIOR2017-3404319.004.jpg
case_images: PMC5352865_01_CRIOR2017-3404319.004.jpg
case_images: fig4
case_images: We performed posterior decompression under microscopy guidance, after completing posterior fixation with pedicle screws from L3 to L5 (Figure 4).
case_images: CT 12 months after surgery. Sagittal image at the midspinal canal (a); coronal image at the midvertebral body (b). Bridging bone formation is present at the edge of the cage inserted at the L3/4 and L4/5 intervertebral spaces.
case_images: CRIOR2017-3404319.005.jpg
case_images: PMC5352865_01_CRIOR2017-3404319.005.jpg
case_images: fig5
case_images: CT revealed bridging bone formation at the edge of the cage at the L3/4 and L4/5 intervertebral spaces (Figure 5). Clinical evaluation was performed at 1 year after surgery: the JOA score was 27/29 (3-3-3, 2-2-2, 2-2-2-1-2-1-2, 0), and the JOABPEQ score was 100 points for lumbar back pain, 50 points for lumbar function, 100 points for walking ability, 100 points for social-life function, and 54 points for mental health.