Flatback Syndrome

What is it?

When evaluating from the side, there are four natural curves of the human spine – two lordotic curves and two kyphotic curves that alternate to create an “S” like shape. These natural curves balance one another so that the head is directly over the hips.  When looking from behind it is normal to have a straight spine with the head centered over the pelvis. When there is an imbalance of one of these natural curves a patient’s entire spinal alignment adjusts so that the patient can continue to stand upright. Flatback syndrome occurs when the lower back loses its natural curvature and becomes flat over time. As a consequence, the spine becomes unbalanced, and the patient starts to lean forward.

Multitude of conditions can cause the flatback syndrome: degenerative disc disease, Vertebral compression fracture, Ankylosing Spondylitis, and Lumbar Post Laminectomy Syndrome.

Symptoms

In addition to the appearance of their backs, patients with flatback syndrome may also have:

  • A sensation of falling forward
  • Chronic pain in the back muscles
  • Difficulty with certain daily activities
  • Fatigue

Diagnosis

Diagnosis is made through a thorough physical exam, patient history, and x-rays of the spine. Often advanced imaging including magnetic resonance imaging (MRI) or computed tomography (CT) scan is also needed to help identify other issues, including spinal stenosis.

Treatment

Non-operative, or conservative, treatments for flatback syndrome include an appropriate exercise routine which consists of aerobic fitness, weight bearing exercises, and core muscle strengthening. Specialized physical therapy and spinal manipulation can be beneficial as well. Medications commonly are utilized to manage pain.

Surgery may be needed for certain patients that fail non-operative measure or whose deformity is worsening over time leading to other neurologic symptoms like pain, numbness, or weakness. The goal of surgical treatment of flatback syndrome is to restore lordosis, thus improving a patient’s overall alignment, quality of life, and stop progression of this spinal deformity.

Surgery to correct flatback deformity may be performed from multiple or combined approaches.