Figure 4

A 59-year-old male with low back pain and gait disturbance due to postural abnormalities. Preoperative radiological parameters showed poor global alignment with Cobb angle 32.2°, coronal decompensation 27.7 mm, LL 6.7°, L1–L2 angle −8.3°, and PI-LL 33.3°. Residual L1–L2 local kyphosis was apparent after the 1st and 2nd operations, and progressive proximal junctional kyphosis with severe low back pain appeared postoperatively.