Fig. 2. A 61-year-old female patient complained of back pain and left sciatica. She had an approximate 20-year history of back pain attacks. During the latest attack, she noticed sciatica in her left leg. (A) The T2-weighted sagittal magnetic resonance imaging (MRI) showed spontaneous L5–S1 level fusion (yellow arrow) and herniation at level L4–5 (white arrow). (B) The axial section of T2-weighted MRI showed protrusion of the disc on the left side (white arrow). The lateral direct X-ray (C) and anteroposterior X-ray (D) were taken 2 years after the operation performed using dynamic screws (blue arrows) and a dynamic rod (red arrows) (BalanC; Medtronic Sofamor Danek). Postoperatively, the patient had no complaint of back pain or severe back pain attacks.