case_images: PMC11222007_01
case_images: X-ray anteroposterior (a) and lateral preoperative views (b/c) showing previous instrumentation post-fracture intervened years before with lumbar lordosis 28 .
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case_images: PMC11222007_01_CRIOR2024-9975362.001.jpg
case_images: fig1
case_images: In the lateral view, an image of geographic aspect was observed in the vertebral body of L5 without vertebral insufflation or loss of vertebral height (Figure 1).
case_images: CT sagittal, coronal, and axial images. Sagittal view shows incomplete septum at L5 vertebral body.
case_images: CRIOR2024-9975362.002.jpg
case_images: PMC11222007_01_CRIOR2024-9975362.002.jpg
case_images: fig2
case_images: The computed tomography (CT) study showed a lytic lesion that occupied and replaced practically the entire vertebral body of L5, with incomplete septum and sclerotic edge, with cortical integrity and no calcifications inside (Figure 2).
case_images: MR shows a homogeneous cystic image, hypointense in T1 sequence and hyperintense in T2, without liquid level.
case_images: CRIOR2024-9975362.003.jpg
case_images: PMC11222007_01_CRIOR2024-9975362.003.jpg
case_images: fig3
case_images: T1 sequence and hyperintense in T2, without liquid level, compatible with the presence of liquid content. The rest of the spine showed no other findings except minimal lumbosacral degenerative facet changes (Figure 3).
case_images: Drainage of cystic lesion. Hematoxylin and eosin staining. (a) Panoramic image of the material obtained in the drainage of the cavity, mostly hematic. (b) Hematic material with lymphocytes and isolated macrophages. (c) Lymphocyte aggregates with trapped mature adipocytes. (d) Hematic material containing small fragments of bone tissue. No osteoid material, atypical or pleomorphic cellularity, or multinucleated giant cells are observed. Neither epithelial nor endothelial cellularity is observed.
case_images: CRIOR2024-9975362.004.jpg
case_images: PMC11222007_01_CRIOR2024-9975362.004.jpg
case_images: fig4
case_images: All this is compatible with simple bone cyst (Figure 4).
case_images: Intraoperative imaging showing PMMA injection and its irregular distribution.
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case_images: PMC11222007_01_CRIOR2024-9975362.005.jpg
case_images: fig5
case_images: Under general anaesthesia, filling of the cavity with radiopaque substance (cystography) was performed through the left L5 transpedicular route in order to see the distribution of the contrast, observing during its introduction, the fall of a fragment of the cystic wall into the cavity, which was identified as "fallen leaf sign." An attempt was made to fill the cavity with PMMA to reduce pain and prevent fracture of the vertebral body (Figure 5), and during its introduction, an irregular distribution of the contrast was observed.