case_images: PMC7771496_01
case_images: Case 1. A sagittal T2-weighted image of magnetic resonance imaging (a). A sagittal image of computed tomography after myelography (b). Preoperative lateral plain radiograph of the total spine (c). Postoperative anteroposterior (d) and lateral (e) plain radiograph of the lumbar spine. Lateral plain radiograph of the total spine after surgery (f) and at the final follow-up (g).
case_images: SNI-11-437-g001.jpg
case_images: PMC7771496_01_SNI-11-437-g001.jpg
case_images: F1
case_images: Magnetic resonance imaging (MRI) was performed, with T2-weighted images (T2WI) showing a low signal intensity in L5 with canal stenosis [Figure 1a]. Type A3.2) [Figure 1b]. Total spinal X-ray showed spinal deformity with 26  of lumbar lordosis (LL), 18  of pelvic incidence (PI)-LL, 27  of T1 pelvic angle (TPA), and 151 mm of sagittal vertical axis (SVA) [Figure 1c]. The preoperative (preop) Japanese Orthopaedic Association (JOA) score was 8 points. We performed an L5 vertebroplasty with hydroxyapatite (Apaceram HA block U4-004-BA, Hoya Pentax, Tokyo, Japan), decompression at L4-5, posterior lumbar interbody fusion (PLIF) at L5-S1, and posterior spinal fusion from L2 to the pelvis [Figure 1d and e]. Spinal alignment after the surgery, which included LL, PI-LL, TPA, and SVA, improved to 41 , 7 , 17 , and 101 mm, respectively [Figure 1f]. Values at 20 months after the surgery were 6 , 43 , 34 , and 143 mm [Figure 1g]. Bony fusion was observed at the L5-S1 PLIF level at the final follow-up [Figure 1g].
case_images: PMC7771496_02
case_images: Case 2. A sagittal T2-weighted image of magnetic resonance imaging (a). A sagittal image of computed tomography after myelography (b). Preoperative lateral plain radiograph of the total spine (c). Postoperative anteroposterior (d) and lateral (e) plain radiograph of the lumbar spine. Lateral plain radiograph of the total spine after the surgery (f) and at the final follow-up (g).
case_images: SNI-11-437-g002.jpg
case_images: PMC7771496_02_SNI-11-437-g002.jpg
case_images: F2
case_images: The sagittal T2WI of the MRI indicated a low signal intensity in the L5 [Figure 2a]. Type A3.3) [Figure 2b]. Total spinal X-ray demonstrated that there was a spinal deformity with 7  of LL, 38  of PI-LL, 33  of TPA, and 198 mm of SVA [Figure 2c]. Preop JOA score was 11 points. We performed L5 vertebral column replacement using the NOVEC VC cage (Alphatec Spine, Inc., CA, USA) and posterior instrumentation from L3 to the pelvis [Figure 2d and e]. Spinal alignment after the surgery, which included LL, PI-LL, TPA, and SVA, improved to 13 , 25 , 22 , and 103 mm, respectively [Figure 2f]. At 3 years after the surgery, these spinal alignment parameters worsened to 90 , 34 , 24 , and 115 mm [Figure 2g]. At the final follow-up, the vertebral column replacement site was fused [Figure 2g].
case_images: PMC7771496_03
case_images: Case 3. A sagittal T2-weighted image of magnetic resonance imaging (a). A sagittal image of computed tomography after myelography (b). Preoperative lateral plain radiograph of the total spine (c). Postoperative anteroposterior (d) and lateral (e) plain radiograph of the lumbar spine. Lateral plain radiograph of the total spine after surgery (f) and at the final follow-up (g).
case_images: SNI-11-437-g003.jpg
case_images: PMC7771496_03_SNI-11-437-g003.jpg
case_images: F3
case_images: The sagittal T2WI of the MRI demonstrated that there was low signal intensity in the L5 with canal stenosis [Figure 3a]. Type A3.3), and canal stenosis at L3-4 and L4-5 [Figure 3b]. Total spinal X-ray showed spinal deformity with 17  of LL, 64  of PILL, 53  of TPA, and 109 mm of SVA [Figure 3c]. Preop JOA score was 11 points. We performed PLIF at L4-5 and L5- S1, with total facetectomy of L4-5 and L5-S1, and posterior instrumentation from L2 to the pelvis [Figure 3d and e]. Spinal alignment after the surgery, which included LL, PI-LL, TPA, and SVA, improved to 35 , 43 , 33 , and 58 mm, respectively [Figure 3f]. However, at the final follow-up, these spinal alignment parameters worsened to 9 , 69 , 57 , and 115 mm, due to other thoracolumbar vertebral fractures [Figure 3g]. The two-level PLIF achieved fusion at the final follow-up [Figure 3g].