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. 2020 Sep 2;21:591. doi: 10.1186/s12891-020-03622-6

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© The Author(s) 2020

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

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Fig. 2 — Case 18. A 66-year-old woman with breast cancer metastasis at L1. a Preoperative sagittal T2 magnetic resonance image revealing tumor involvement at L1. b Lateral radiograph revealing pathological fracture at L1. c Lateral radiograph after total en bloc spondylectomy. d Radiographs at 18 months after surgery revealing increased local kyphosis angle between T12 and L2. e Coronal computed tomography (CT) scan revealing breakage of the left rod. f Posterior instrumentation is exposed using the previous midline incision. g The left rod is broken at the area proximal to the L2 pedicle screw. h Loosening pedicle screw at the left T11 level is replaced, and four cobalt chromium rods are inserted. i Autologous bone graft is placed on adjacent T12 and L2 lamina and scar tissue of the resected L1 lamina area. j, k Radiograph after revision surgery. l Sagittal CT scan at 42 months after revision surgery revealing bone fusion within the cage and at the posterior bone graft