A case of pseudo-reverse cortical sign: implications for surgical decision-making
Moataz A. Ahmed, Mohammad N. Ezz-ElarabBackground and aim
The reverse cortical sign (RCS) is a crucial radiological key in thoracolumbar fracture. Nonetheless, a related yet different radiologic mimic, the pseudo-reverse cortical sign (PRCS), has gained increasing attention. The aim of this study is to describe an infrequent instance of PRCS in a thoracolumbar burst fracture and to bring out the distinction in the diagnosis of a PRCS and a RCS, which carries significant implications for surgical planning.
Patients and methods
The patient with an L3 burst fracture and incomplete cauda equina syndrome was in his 22nd year and was assessed using plain radiographs, multiplanar computed tomography, and intraoperative fluoroscopy. Direct manual fragment reduction, a posterior approach, and short-segment transpedicular fixation were done. Postoperative and 1-month follow-up assessment of neurological recovery was carried out.
Results
Imaging demonstrated the presence of a pseudo-reverse cortical fragment, which retained its orientation, obviating the need for an anterior approach. The posterior-only surgery performed reached the correction of kyphosis, reconstruction of vertebral height, and sufficient canal decompression. One month later, quadriceps strength was Grade 4, ankle dorsiflexion was Grade 5, and the sensory deficits and urinary retention were much improved.
Conclusion
Preoperative distinction between PRCS and actual RCS should be done correctly in order to prevent unwarranted anterior surgery. Direct manual reduction and short-segment fixation (a posterior-only) is effective in the management of PRCS with an accurate diagnosis.