Figure 3.

(A) A 61-year-old woman presented with low back pain and L5 radiculopathy after two previous lumbar spine instrumented fusion. Clinical and radiological assessment showed lumbar flat back syndrome and L5–S1 degenerative lumbar disc. (B) Patient was managed with L5–S1 transforaminal lumbar interbody fusion, with extension of the instrumented fusion to the ilium. Patient back pain and sagittal imbalance improved after the surgery. The sagittal vertical axis improved from 8 cm preoperative to 2 cm postoperative.