case_images: PMC8720427_01
case_images: The preoperative antero-posterior and lateral radiograph of the spine. (a) The antero-posterior radiograph demonstrates an enlarged lytic lesion with predominant involvement of the left side of sacrum and lower lumbar vertebrae.
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case_images: PMC8720427_01_SNI-12-580-g001.jpg
case_images: F1
case_images: Plain lumbosacral X-rays showed an enlarged lytic lesion involving predominantly the left side of the sacrum and lower lumbar vertebrae L4-S2 [Figure 1].
case_images: (a) T2-weighted MRI scan (sagittal cut) of the whole spine demonstrates 85 x 75 x 140 mm sized, large multi-loculated expansible mass with soap-bubble-like appearance occupying the region of L4, L5, S1, and S2. (b) CT scan (axial cut) shows a large lytic lesion involving both the sacral alae.
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case_images: PMC8720427_01_SNI-12-580-g002.jpg
case_images: F2
case_images: The MR demonstrated a large, multi-loculated, expansile mass with a soap-bubble-like appearance from L4-S2, which extended to the neural foramina, sacroiliac joints, and paravertebral muscles; findings were consistent with the diagnosis of an ABC [Figure 2]. The lumbosacral CT showed a lytic lesion involving the sacral alae, part of the S1and S2 vertebral bodies, and destruction of the left L5 pedicle [Figure 2].
case_images: Intra-operative clinical image after extended curettage and decompression.
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case_images: F3
case_images: The patient underwent preoperative selective arterial embolization on the day of surgery, followed by an extended curettage [Figure 3].
case_images: The post-operative anteroposterior and lateral radiograph of the spine. (a) Antero-posterior radiograph demonstrates bilateral pedicle screw fixation at L4, right-sided L5, and S1 pedicle screw fixation with a left trans-iliac pedicle screw and an anterolateral inter-body fusion at L5-S1 level. (b) The lateral radiograph demonstrates the screw and rod construct with the cage at the above-described levels.
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case_images: F4
case_images: L4-S2) [Figure 4].
case_images: Follow up radiograph of the spine with the pelvis at 2 years post-surgery. (a) The antero-posterior radiograph shows the loosening of the set screw on the left side. (b) The lateral radiograph demonstrates loosening of the set screw inferiorly.
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case_images: PMC8720427_01_SNI-12-580-g005.jpg
case_images: F5
case_images: The only focal asymptomatic finding on radiography was the loosening of the set screw on the left side inferiorly [Figure 5].