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case_images: (A)-(D) Initial plain radiographs and MR images showing the L1 bony Chance fracture featured with spinous fracture (white arrow). (E)-(H) Subsequent plain radiographs and MR images showing vertebral body collapse and intravertebral vacuum cleft (white arrowhead) with canal encroachment. MR: magnetic resonance.
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case_images: Plain radiograph and magnetic resonance imaging showed a L1 bony Chance fracture without canal encroachment (Figures 1A-1D). Subsequent imaging studies showed further collapse and intravertebral vacuum cleft (IVC) formation at fracture site (Figures 1E-1H).
case_images: Thoracolumbar plain radiograph and computed tomography showing anterior longitudinal ligament ossification (white arrow) at more than 4 consecutive levels (A) without evidence of sacroiliitis (B).
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case_images: Moreover, he was diagnosed with DISH, where ossification of the anterior longitudinal ligament was present at more than 4 consecutive levels (Figure 2A) with no evidence of sacroiliitis or human leukocyte antigen-B27-related AS (Figure 2).
case_images: Serial computed tomography coronal and sagittal scans showing solid bony fusion replacing the intravertebral vacuum cleft at 3 months (A), 6 months (B), 10 months (C), and 14 months (D) after trauma.
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case_images: Serial imaging studies showed IVC regression and solid bony union after 12 months of daily teriparatide injection despite thoracolumbar kyphosis (Figure 3).