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What is Flatback Syndrome?

Judy Dorsett

Judy Dorsett was diagnosed with scoliosis at age 16 and underwent multiple fusion surgeries to correct her double curve. 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 was no longer able to 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. The very first day after surgery, she stood up… and she stood up straight. Two weeks later she came back to follow up with Dr. Hostin, and she was pain free!

So, what is flatback syndrome?

In these X-rays taken before and after her surgery, you can see how difficult it was for Judy to maintain an upright posture.

The spine has several natural curves that help us balance the weight of our bodies, walk normally, and stand upright. There are inward curves (known as lordosis, or lordotic curves) in the neck and lower back, and there is the outward curve (known as kyphosis, or kyphotic curve) in the middle of the spine. These curves are what give the spine its characteristic “S” shape, and they are critically important.

When a person loses the natural curve in their back and the spine becomes straight (or flat), it can lead to a number of symptoms – such as pain, inability to stand upright – that are collectively referred to as flatback syndrome.

How do you know if you have flatback syndrome?

The most common and obvious symptom of flatback syndrome is difficulty standing up straight, which causes patients to stoop forward and leads to a host of other symptoms. Patients with a flat back posture often need to bend at the hips and knees to stand upright, which 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 means that many patients require a cane or walker to help them get around, and they 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 sciatica or spinal stenosis, causing pain and weakness in the legs that gets worse when walking.

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

What causes flatback syndrome?

One of the more common reasons we see patients come in with flat back posture is a history of spinal fusion surgeries – especially using earlier techniques and instrumentation. While many patients do well for decades after surgery, early fusion techniques could cause the disks 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.

In addition, there are other conditions that can 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 Disk Disease. As we age, the disks in our spine (which act as shock absorbers between the vertebrae) begin to deteriorate. These disks 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 (new bone formation and fusion) causing 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 it is much more common is older adults with osteoporosis, which can substantially weaken the bone.

Post-Laminectomy Syndrome. Laminectomy is a surgery that creates 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.

How is flatback syndrome diagnosed?

Diagnosis of flatback syndrome is usually done 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.

The next step is to get a full-length X-ray of the spine. Southwest Scoliosis Institute uses a state-of-the-art X-ray imaging system that can take high-quality images of patients in just 10-25 seconds. This system can also take X-rays of patients in a standing or seated position, and it’s conveniently located inside our Dallas location, meaning you and your physician can review the X-rays immediately after they are taken.

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

How do you fix flatback syndrome?

Some patients with flatback syndrome can be treated without surgery, and the doctors at Southwest Scoliosis Institute always use the most conservative method to treat a condition before recommending surgery.

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

Surgical reconstruction for flatback syndrome is usually accomplished with an osteotomy procedure, which involves removing one or more wedge-shaped sections of bone from the spinal column in order to restore lordosis to the lumbar vertebrae. Instrumentation (rods and screws) may then be inserted to ensure that the spine is stable so that it can fuse and heal properly.

Southwest Scoliosis Institute specializes in treating complex spinal conditions and revision surgery

If you think you may have flatback syndrome, it’s critical to consult a physician who is skilled in treating complex spinal conditions in adults – especially if it’s the result of an earlier surgery performed by someone else. At Southwest Scoliosis Institute, our board-certified, fellowship-trained orthopedic surgeons have performed more than 5,600 successful spine surgeries.

Dr. Richard Hostin, Dr. Ioannis Avramis and Dr. Shyam Kishan 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) 308-0227 or visit our contact page today!

Click the link below to hear Judy’s story firsthand.