case_images: PMC3913434_01
case_images: Preoperative imagiologic study; involvement of T8 by the giant-cell tumor as presented in plain radiograph (A), CT scan (B) and MRI (C and D). Notice the tumor mass protruding into the vertebral canal.
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case_images: RJT131F1
case_images: She performed a computed tomography (CT) scan and magnetic resonance imaging (MRI), which better defined the bone involvement and already revealed invasion of the medullary canal (Fig. 1).
case_images: Intraoperative photographs; after total en bloc spondylectomy (A), anterior-column reconstruction was accomplished with placement of a titanium cage with structural allograft (B) and was complemented with pedicle screw-rod fixation (C). (D) Resected vertebra.
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case_images: RJT131F2
case_images: T8 by a posterior-only approach was performed (Fig. 2). The operation followed the technique proposed by Tomita et al. and was complemented with anterior-column reconstruction with a titanium mesh filled with structural allograft, as well as pedicle screw instrumentation, from T6 to T10 (Fig. 3).
case_images: Postoperative radiographic appearance.
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case_images: RJT131F3
case_images: T8 by a posterior-only approach was performed (Fig. 2). The operation followed the technique proposed by Tomita et al. and was complemented with anterior-column reconstruction with a titanium mesh filled with structural allograft, as well as pedicle screw instrumentation, from T6 to T10 (Fig. 3).
case_images: Bilateral hemothorax requiring drainage.
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case_images: RJT131F4
case_images: A CT scan confirmed bilateral hemothorax requiring bilateral thoracentesis (Fig. 4), after which she immediately recovered from the previous symptoms. 
case_images: Postoperative thoracic CT scan; large septated empyema, extending from the surgical site to both pleural cavities, was found to be the cause of deterioration of the patient's general condition.
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case_images: RJT131F5
case_images: A new CT scan was performed, revealing a moderate fluid collection in both lungs, compatible with empyema (Fig. 5).
case_images: Revision procedure; a thoracotomy was performed for pus drainage and debridement, as well as removal of the anterior cage and allograft (A). A tricortical iliac bone autograft was used to maintain anterior-column stability (B). Postoperative radiographic study (C and D).
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case_images: RJT131F6
case_images: Due to the ongoing postoperative infection, a new operation was undertaken with surgical debridement of the infected tissues, allograft and titanium mesh extraction, which were replaced by iliac crest tricortical autograft for anterior support (Fig. 6).
case_images: (A) CT scan coronal reconstruction showing recurrence of paravertebral empyema. (B) Intraoperative image following posterior debridement.
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case_images: RJT131F7
case_images: Concurrently, a newly resurged septated empyema had developed in the paravertebral space, which demanded for a combined anterior and posterior approach, for complete drainage (Fig. 7).
case_images: Current patient status.
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case_images: RJT131F8
case_images: Currently, after 9 months from the initial surgery, the patient remains stable and asymptomatic with no evidence of infection or tumor relapse (Fig. 8).
case_images: CT scan with no evidence of tumor relapse or instrumentation failure.
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case_images: RJT131F9
case_images: The follow-up imaging studies show encouraging evolution without bone graft resorption or failure of the instrumentation (Fig. 9).