A 51-year-old man, welder, still working, became progressively disabled due to intractable back pain and transient radicular pain with claudication. He had no previous surgery history and had in the past frequently treated lumbalgia by rest and painkillers. The patient is pain-free at night but endures increasing pain during daily activities and work. He cannot stand straight and is permanently bent forward. He has transient radicular claudication; neurologic exam is normal at rest. MRI shows multiple degenerative discs in the lumbar spine without canal stenosis or hernia. Facet arthrosis is present but posterior muscles are still good. Full standing films show a straight spine on AP view and a significant lumbar kyphosis with global imbalance on lateral view.
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