Fig. 5

a A 68-year-old female patient with DLSS and sagittal imbalance syndrome. b Paravertebral muscles from L1–2 to L4–5 were featured with fatty infiltration, with a mean infiltrated percentage of 32.86% and a mean muscle/disk ratio of 1.46. c A long fusion from T11 to S1 with lumbar decompression and sagittal realignment was performed. At 24-month follow-up, the global sagittal malalignment and imbalance were completely regulated, without any mechanical complication