Fig. 1.

An 81-year-old male underwent laminectomy with L3–L5 fusion 15 years ago. He presented with lumbar back pain with bilateral numbness and paresthesia in his 5th toes aggravated over the past 2 years and was resistant to medical treatment. (A) Complete spine X-ray and (B) computed tomography scanning and magnetic resonance imaging showed adjacent segment disease and degenerative scoliosis. (C) He underwent corrective osteotomy, and the postoperative course was unremarkable. (D) One month later, he presented with back pain and lower limb weakness following an abrupt movement. X-ray showed proximal junctional kyphosis. (E) He underwent an extension of his arthrodesis to T2.