What is Flatback Syndrome?

When the lower back (lumbar spine) loses its normal swayback curve (lordosis) this can result in FLATBACK DEFORMITY.  The main symptoms of Flatback Deformity are difficulty standing up straight often associated with low back or leg pain.  Typically, these symptoms get worse towards the end of the day as the muscles supporting the back and legs fatigue.  In an attempt to adjust for the Flatback Deformity, patients may extend their hips by rotating the pelvis backwards and/or bend their knees causing pain in the buttocks or in the front of the thighs.  Flatback Deformity may be associated with nerve trouble resulting in sciatica or weakness/numbness of the legs.  The pain and stooped posture may become disabling, requiring increasing pain medications and limiting day-to-day activities.

There are many causes of Flatback Deformity.  The original description was following surgery for Scoliosis with Harrington rods that stretched out the normal swayback in the lumbar spine when the rods extended to the lower lumbar spine.  With current scoliosis techniques, this problem is much less common.

Other causes of Flatback Deformity include:

• priorsurgery in which the spine was fused with inadequate curve
• loss of curve following spinal decompression surgery (post-laminectomy kyphosis)
• multiple levels of severe disc degeneration and collapse
• vertebral compression fractures
• other less common conditions such as Ankylosing Spondylitis and Parkinson’s Disease.

Non-surgical treatment for Flatback includes physical therapy and anti-inflammatory medications.  Muscular rehabilitation and exercise programs may help in some patients, however, if the deformity is significant, surgery may be necessary.  Surgery is aimed at restoring the normal alignment and often involves a spinal osteotomy.  An osteotomy is a wedge shaped removal of bone that is used to correct the abnormal alignment.

A) Preoperative photo of patient with post-fusion flatback deformity. B) Preoperative x-ray of the same patient showing screws and rods with a flatback deformity. C) Postoperative photos of the same patient one year after surgical correction of the flatback deformity. D) Postoperative x-ray of the same patient.

I hope this information was helpful, please let me know if I may be of service. Thank you.

For more information:

https://www.srs.org/patients-and-families/conditions-and-treatments/adults/other-spine-deformities-and-conditions

About Orange County Orthopedic Spine Surgeon, Dr. Samuel Bederman:

Dr. Samuel Bederman is a double-fellowship trained orthopedic spine surgeon practicing at Restore Orthopedics and Spine Center in Orange County. Dr. Bederman received his medical degree from the University of Toronto before moving on to his residency in Orthopedic Surgery. He then became a fellow of the Royal College of Surgeons of Canada in Orthopaedic Surgery and also studied at the Royal Adelaide Hospital in Australia. After completing his fellowship, he completed a Doctor of Philosophy in health services research and clinical epidemiology at the University of Toronto. Soon after, Dr. Bederman returned for his second clinical fellowship specializing in scoliosis, spinal deformities and revision spinal surgery at the University of California at San Francisco.

Dr. Bederman specializes in adult and pediatric scoliosis, robotic spine surgery, complex revision cervical, thoracic, and lumbar surgery, and minimally invasive spinal surgery. Dr. Bederman is passionate about spine education and has taught as Assistant Professor at the University of California at San Francisco, Stanford University, as well as at the University of California at Irvine. He has trained dozens of surgeons in the techniques of Robotic Spine Surgery around the country.

He has spoken on spinal surgery at society meetings all around the world and authored numerous peer-reviewed journal articles and book chapters.  He is a member of the Scoliosis Research Society, the North American Spine Society, the International Society for the Study of the Lumbar Spine, AO Spine North America, the American Orthopaedic Association, and the American Association of Orthopaedic Surgeons.

To view a list of Samuel Bederman’s impressive contributions to spine health research and education presenting professional articles, publications and speaking engagements to national and international audiences, click HERE

Dr. Bederman sees local as well as international patients.  Consultations can be made by calling 714.598.1745