Flatback Syndrome

July Dorsett Flatback Syndrome patientJudy Dorsett was diagnosed with scoliosis at age 16 and underwent multiple fusion surgeries to correct her double curve. Watch her full video and hear her story at the bottom of this page.

For many years, Judy was fine. However, as she grew older, she began to experience pain in her back, legs, and hips. In addition, she found that she could no longer stand up straight, limiting her ability to get around easily.

Dr. Richard Hostin diagnosed Judy with a condition known as Flatback Syndrome and recommended revision surgery to correct the problem. Consequently, the very first day after surgery, she stood up… and she stood up straight. Then two weeks later she came back to follow up with Dr. Hostin, and she was pain-free!

What is Flatback Syndrome?

Flatback syndrome refers to a condition whereby the lower spine loses some of its natural curvatures. It causes a form of sagittal imbalance in the spine.

The spine has several natural curves that help us balance the weight of our bodies, walk normally, and stand upright. These curves help in carrying the weight of the trunk, arms, and neck. The spine curves a little bit backward where it joins the pelvis. This curve is known as lordosis. Also, the spine curves slightly forward where it joins the ribs at the chest level. This curve is known as kyphosis.

Flatback Posture

Furthermore, these curves are what give the spine its characteristic “S” shape. Flatback posture occurs when a person loses the natural curve in their lower back and the spine becomes straight. When your back loses its curves, this can lead to several symptoms such as pain, inability to stand upright, or having to take breaks when walking. Moreover, these symptoms lead doctors to diagnose flatback Syndrome.

The flatback syndrome occurs when there is no lordosis or kyphosis or both, thereby straightening the spine. Lordosis occurs naturally in two places in our spine, in the lumber section (low back) and in the cervical or neck section of the spine. Kyphosis is a severe rounding of the back.  Kyphosis Patients with the flatback syndrome usually appear stooped forward and may find it difficult to stand up straight.

How Do You Know If You Have Flatback Syndrome?

Those with the flatback syndrome may not know that they have the condition since the spine has been gradually changing with time or sometimes caused by incorrect surgery. Sometimes, patients can end up with flatback after surgery because the usual curves the spine needs are no longer present. Patients with flatback syndrome lose lordosis in their spine. As a result, their body will adapt by tilting the pelvis and flexing the hips and knees thereby allowing the patient to stand upright.

Patients with the flatback syndrome usually visit spine centers due to symptoms such as back or leg pain and difficulties with carrying out daily activities. Patients may also experience a poor posture that gets worse over time and may end up using a cane or walking stick while walking. These symptoms usually get worse as the day passes due to excess fatigue in the muscles. In some cases, the patients may also have spinal stenosis (i.e. a narrowing around the spinal canal that causes nerve symptoms).


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Judy Dorsett was diagnosed with scoliosis at 16 years old and had two surgeries when she was younger to try and correct the condition. However, as she grew older, she experienced severe pain in her back, legs, and hips. It even hurt to roll over in bed at night, the worst pain she had ever felt. Dr. Richard Hostin diagnosed her with “flatback” resulting from one of her previous spinal fusions that never healed properly. She stood up the very first day after surgery… and she stood up straight. Two weeks later, and she was pain-free and still continues to this day! ~ Judy Dorsett, Flat Back Patient

Flatback Causes

Flatback Syndrome causes difficulty in standing up straight. Unfortunately, this syndrome causes patients to stoop forward and leads to a host of other symptoms. Also, patients with a flat back posture often need to bend at the hips and knees to stand upright. And so, this leads to pain and fatigue in the legs that gets worse as the day goes on.

The chronic pain and stooped posture associated with Flatback Syndrome also mean that many patients require a cane or walker. These patients may develop pain in their neck and upper back as they strain to try and keep their eyes facing forward. In some cases, patients also experience symptoms of adult scoliosis, sciatica, or spinal stenosis. This causes pain and weakness in the legs that can get worse when walking.

All of these symptoms can become exhausting and painful and may require patients to take prescription pain medications just to function.

What Causes This Ailment or Syndrome?

Judy before surgery standing and xrayOne of the more common reasons we see patients come in with flat back posture is a history of spinal fusion surgeries – especially using earlier surgical techniques and instrumentation. While many patients do well for decades after surgery, early fusion techniques could cause the discs below the fused section to quickly degenerate, leading to a loss of natural curvature.

With modern spinal fusion techniques and new types of instrumentation, surgeons are now able to preserve much more of the normal spinal alignment and curvature. As a result, the chances of developing Flatback Syndrome as a result of fusion surgery are much lower than in the past.

Flatback syndrome can also occur after laminectomy (a form of spine surgery). Surgically implanted devices that were used to correct scoliosis in the past can flatten the lumbar spine, thereby leading to flatback syndrome. This complication has been reduced by advancements in surgical techniques.

Also, other conditions cause a reduction in the natural curvature of the back, causing Flatback Syndrome. These conditions are usually associated with aging and most often affect older adults, including:

Degenerative Disc Disease

As we age, the discs in our spine (which act as shock absorbers between the vertebrae) begin to deteriorate. These discs contribute to the normal curvature of the back, and this degeneration can cause the spine to flatten out.

Ankylosing Spondylitis

This arthritic inflammation of the spine can cause stiffness, and in advanced cases, lead to ankylosis. Ankylosis means new bone formation and fusion that causes sections of the spine to fuse in a flat, immobile position.

Vertebral Compression Fractures

A vertebral compression fracture occurs when one or more bones in the spine (vertebra) become compressed and collapse. This may occur in anyone as a result of trauma, but we see this problem with older adults with osteoporosis.

Post-Laminectomy Syndrome

A surgeon performs a laminectomy to create space in the spinal canal (usually to relieve pressure on the spine) by removing a portion of the vertebra. In some cases, this procedure can cause a decrease in lordosis, leading to a Flatback Deformity.

Diagnosis of Flatback Syndrome

The Diagnosis of Flatback Syndrome occurs through a combination of the patient’s history, a physical examination, and X-rays of the spine. Patients with Flatback Syndrome typically present with a history of prior surgery, as well as difficulty standing upright and associated back and leg pain.

Then, a full-length X-ray of the spine is the next step. Southwest Scoliosis and Spine Institute has a state-of-the-art X-ray imaging system. This system takes high-quality images of patients in just 10-25 seconds.  In addition, it takes these scans with smaller amounts of radiation than conventional x-ray systems. This system can also take X-rays of patients in a standing or seated position. It’s conveniently located inside our Dallas location, meaning you and your physician can review the X-rays immediately.

In addition to X-rays of the bones, your physician may also order an MRI or CT scan. This will identify any problems in the soft tissue. Such as the spinal cord, nerves, and/or discs to determine the best and safest course of treatment.

How Do You Fix Flatback Syndrome?

The main aim of treatment for flatback syndrome is to improve the quality of the patient’s life by improving the symptoms.

Some patients with Flatback Syndrome can undergo treatment that does not include surgery or minimal surgery, like in Judy’s case (watch the video below.) The doctors at Southwest Scoliosis and Spine Institute always utilize the most conservative method to treat a condition before recommending surgery.

Non-Surgical Treatment

Nonsurgical treatments for flatback syndrome include exercise and physical therapy designed to increase core strength and provide symptomatic relief. Furthermore, doctors use pain management using non-steroidal anti-inflammatory drugs (NSAIDs). For patients with joint arthritis or pinched nerves, epidural steroid injections may also provide relief.


Judy after surgery standing and xraySurgical reconstruction for Flatback Syndrome is usually accomplished with an osteotomy procedure or a tweak of previous surgery hardware.  The osteotomy procedure involves removing one or more wedge-shaped sections of bone from the spinal column to restore lordosis to the lumbar vertebrae. Doctors will sometimes also insert rods and screws to ensure that the spine is stable so that it can fuse and heal properly.

Southwest Scoliosis and Spine Institute Specializes in Treating Complex Spinal Conditions and Revision Surgery

At Southwest Scoliosis and Spine Institute, our spine specialists educate patients on their unique spinal conditions.  They discuss the different treatment options (both surgical and non-surgical), and the risks and benefits of each. Since the flatback syndrome is a structural problem that involves either a former surgical technique or degenerative disc disease and instability in the spine, it may require surgical reconstruction.

Patients that fail non-surgical treatments or those with a severe deformity that is associated with other neurologic symptoms may require surgery. The goal of the operative treatment of flatback syndrome is to restore lordosis, thereby improving the overall alignment and quality of life of the patient. Our flatback treatment options will stop the deformity from progressing.

Make an Appointment

If you think you may have Flatback Syndrome, it is critical to consult a very skilled spine physician. Especially if it’s the result of an earlier surgery performed by someone else. At Southwest Scoliosis and Spine Institute with offices in Dallas, Plano, and Frisco, Texas, our board-certified, fellowship-trained surgeons have performed more than 16,000 successful spine surgeries. Richard Hostin, MDDevesh Ramnath, MDIshaq Syed, MDShyam Kishan, MD, and Kathryn Wiesman, MD have the expertise and surgical skills necessary to diagnose and treat the most complex spine cases and revision surgeries.

If you have been told that there is no hope, call us for an evaluation at (214) 556-0555 or visit our contact page today!


Medical News Today: Flatback Syndrome