In December 2016, this 69 year old female presented to the office with pain in her back for the past 15 years. She had a remarkable history of being involved in a motor vehicle accident about 8 years prior, from which she developed weakness on her left side and required a cervical anterior and posterior fusion surgery due to compression on her spinal cord. She reported that she was able to stand straight prior to the accident, but that over the past 8 years, she was progressively falling over to the left side. She stated that her spine had been curving even more rapidly over the past 3 years. She could not stand upright, as seen in the photo. In addition, she had a history of osteoporosis and chronic pain and was taking multiple pain medications. On examination, she was able to maintain a relatively upright sitting position, however she rapidly leaned off to the left upon standing. She also exhibited signs of persistent spasticity in her upper and lower extremities, residual symptoms from her cervical spine injury. Comparing x-rays from 2007 and 2016, there was a considerable change in her deformity, consistent with a worsening degenerative scoliosis. As evident by her x-rays, she was clearly in a difficult predicament.