case_images: PMC11303050_01
case_images: (a, b) Preoperative radiograph and (c-f) computed tomography images of the lumbar spine. (a) White arrows show indistinct right L3 lumbar pedicle, (c) the fracture lines of the L3 vertebra, and (d-f) absence of the right L3 pedicle.
case_images: CRIOR2024-2671270.001.jpg
case_images: PMC11303050_01_CRIOR2024-2671270.001.jpg
case_images: fig1
case_images: L3 lumbar pedicle (Figures 1(a) and 1(b)). Lumbar lordosis (LL) was 18 , and L2-L4 Cobb angle was 24 . Computed tomography (CT) revealed a fracture line in the L3 vertebral body and the absence of the right L3 lumbar pedicle (Figures 1(c), 1(d), 1(e), and 1(f)).
case_images: Preoperative magnetic resonance image. (a) STIR midsagittal, (b) T2-weighted right parasagittal, and T2-weighted axial ((c) L2-L3 disc level; (d) L3 pedicle level). White arrow: intensity change due to a L3 fracture. Arrowheads: right L2 (upper) and L3 (lower) nerve root.
case_images: CRIOR2024-2671270.002.jpg
case_images: PMC11303050_01_CRIOR2024-2671270.002.jpg
case_images: fig2
case_images: Magnetic resonance imaging (MRI) of the lumbar spine showed a hyperintense signal in the STIR sequence around the L3 vertebral body and an indistinct L2 nerve root in the right parasagittal view (Figure 2).
case_images: Preoperative computed tomography-based 3-dimensional bone model. (a) Dorsal and (b) right lateral views. Arrowheads show hypoplasia of the right L2 lower articular process (lower) and the right L3 transverse process. Black dotted line shows absence of the right L3 pedicle.
case_images: CRIOR2024-2671270.003.jpg
case_images: PMC11303050_01_CRIOR2024-2671270.003.jpg
case_images: fig3
case_images: The 3D model showed hypoplasia of the L2 right lower articular process and L3 right transverse process in the absence of the right L3 pedicle (Figure 3).
case_images: (a) Intraoperative photograph and (b) schema. Three nerve roots occupied the space of the missing right L3 pedicle.
case_images: CRIOR2024-2671270.004.jpg
case_images: PMC11303050_01_CRIOR2024-2671270.004.jpg
case_images: fig4
case_images: We confirmed that the three nerve roots occupied the space of the missing right L3 pedicle (Figure 4).
case_images: Radiographs at (a, b) immediate postoperative period, at (c, d) 4 weeks postoperatively after primary surgery, and (e, f) additional surgery.
case_images: CRIOR2024-2671270.005.jpg
case_images: PMC11303050_01_CRIOR2024-2671270.005.jpg
case_images: fig5
case_images: Postoperative LL was 32 , and L2-4 Cobb angle was 18  (Figures 5(a) and 5(b)). The correction loss of LL occurred because of the cage subsidence, resulting in decreased LL from 32  immediate postoperative period to 16  postoperative 1 month (Figures 5(c) and 5(d)). The loosened L2 screws were replaced with larger screws, and bilateral L1 screws were placed as additional anchors (Figures 5(e) and 5(f)).