case_images: PMC5357515_01
case_images: Crouched standing posture.
case_images: CRIOR2017-1892502.001.jpg
case_images: PMC5357515_01_CRIOR2017-1892502.001.jpg
case_images: fig1
case_images: Inspection of her posture on standing revealed severe sagittal plane deformity including lumbosacral kyphosis and lumbar hyperlordosis with flexion at hips and knees (crouched position) (Figure 1).
case_images: (a) Preoperative A-P radiograph lumbosacral spine. (b) Whole spine standing lateral view radiograph. (c) Flexion-extension lateral view of lumbosacral spine. (d) Sagittal reconstructed CT scan.
case_images: CRIOR2017-1892502.002.jpg
case_images: PMC5357515_01_CRIOR2017-1892502.002.jpg
case_images: fig2
case_images: Plain radiography and computed tomography (CT scan) showed L5 spina bifida occulta, bilateral L5 pars defect, dysplastic L5-S1 facets, trapezoidal L5 vertebral body, retroverted sacrum with rounding of proximal endplate, and complete anterior descent of the L5 vertebrae to the sacrum (Figures 2(a)-2(d)).
case_images: Sagittal T2 weighted MRI image.
case_images: CRIOR2017-1892502.003.jpg
case_images: PMC5357515_01_CRIOR2017-1892502.003.jpg
case_images: fig3
case_images: Magnetic resonance imaging (MRI) of lumbosacral region revealed severe dural compression at L5-S1 level and L5-S1 intervertebral disc degeneration (Figure 3).
case_images: Intraoperative image (1st-stage surgery) showing loose inner nut of L4 pedicle screw (broad arrow) before final wound closure.
case_images: CRIOR2017-1892502.004.jpg
case_images: PMC5357515_01_CRIOR2017-1892502.004.jpg
case_images: fig4
case_images: Rod inserted on this side was secured by tightening of inner screw of L5 and S1 screws, and those of L3, L4, and S2 screws were kept loose (Figure 4).
case_images: Postoperative standing lateral spine radiograph.
case_images: CRIOR2017-1892502.005.jpg
case_images: PMC5357515_01_CRIOR2017-1892502.005.jpg
case_images: fig5
case_images: Objective radiological measurements performed after surgery, which included percent displacement, slip angle, sacral inclination, total lumbar lordosis (L1-L5), and global sagittal balance (plumb line from centre of C7 in relation to posterosuperior edge of sacrum), showed marked improvement on comparison to presurgery measurements (Figure 5).
case_images: A-P and lateral radiograph of lumbosacral spine after 3-year follow-up.
case_images: CRIOR2017-1892502.006.jpg
case_images: PMC5357515_01_CRIOR2017-1892502.006.jpg
case_images: fig6
case_images: Radiological evaluation revealed disengagement of screw rod complex at proximal end of construct along left side and loosening with screw back out of S2 pedicle screws along lower end of the screw assembly (Figures 6(a) and 6(b)).
case_images: A-P and lateral radiograph of lumbosacral spine following 2nd-stage surgery.
case_images: CRIOR2017-1892502.007.jpg
case_images: PMC5357515_01_CRIOR2017-1892502.007.jpg
case_images: fig7
case_images: After preparing the end plates appropriate size titanium mesh cage was inserted, incorporated with bone graft obtained after harvesting autogenous rib (Figures 7(a) and 7(b)).
case_images: A-P and lateral clinical photograph one year postoperatively.
case_images: CRIOR2017-1892502.008.jpg
case_images: PMC5357515_01_CRIOR2017-1892502.008.jpg
case_images: fig8
case_images: During the most recent follow-up of about 12 months following the subsequent surgery, patient is pain-free and fully active and on clinical evaluation her spinal alignment was found to be appropriate (Figures 8(a) and 8(b)).