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  Indian J Med Microbiol
 

Figure 4: X-ray lumbosacral spine lateral view of a 72 year old male (a) preoperative showing L4-L5 degerative spondylolisthesis, (b) immediately after the first surgery showing pedicle screws and cage in situ. Lordosis improved to 9° at L4L5 (c) 8 years after the first surgery showing adjacent segment degeneration at L3L4 level (d) immediately after the second surgery PLIF showing pedicle screws in L3 and cage between L3L4 also (e) 10 years after the first surgery showing adjacent segment degeneration at L2L3 level (f) After third surgery (at final followup) showing fixation at 2 more proximal levels with PLIF at L2L3 level (JOA score improved 17 to 21 points at final followup)

Figure 4: X-ray lumbosacral spine lateral view of a 72 year old male (a) preoperative showing L4-L5 degerative spondylolisthesis, (b) immediately after the first surgery showing pedicle screws and cage <i>in situ</i>. Lordosis improved to 9° at L4L5 (c) 8 years after the first surgery showing adjacent segment degeneration at L3L4 level (d) immediately after the second surgery PLIF showing pedicle screws in L3 and cage between L3L4 also (e) 10 years after the first surgery showing adjacent segment degeneration at L2L3 level (f) After third surgery (at final followup) showing fixation at 2 more proximal levels with PLIF at L2L3 level (JOA score improved 17 to 21 points at final followup)