Flatback syndrome occurs when the low back loses its natural curvature and becomes flat over time. With flatback syndrome there is a decreased lordosis and when this occurs the spine becomes unbalanced and the patient will start to lean forward. Symptoms of flatback syndrome often worsen as the day goes on, as the patient tends to lean further and further forward. The severity of symptoms often depends on the amount of curvature present and associated difficulty with standing upright. Patient’s spine will automatically try to compensate for this imbalance by tilting their pelvis, flexing their knees or hips. This imbalance over time can cause muscle fatigue and pain.
Often the degree of flatback deformity worsens with age as there is natural disc degeneration and collapse over time. The goal of this surgery is to restore the normal lordosis; this is done by surgically removing the degenerative discs and replacing them with implants. These implants restore the disc height loss over time and often are hyper-lordotic implants meaning they also restore lordosis. Some examples of these types of surgeries include anterior lumbar interbody fusion and lateral interbody fusion. The surgery also utilizes screws and rods in the back to stabilize the implants and help fuse the spine in a more normal alignment.
Flatback deformity can occur from a variety of causes that our spinal specialists will assess for during office evaluations. Some risk factors include degenerative disc changes as well as alignment changes related to osteoporosis. Patients can also have flatback related to a previous surgery such as a lumbar laminectomy or possibly an underlying condition such as Ankylosing Spondylitis.
Unfortunately no. With a good exercise regimen patients often can improve their symptoms related to flatback deformity but are not able to change the underlying structural issue.
Surgery may be needed for patients whose deformity is worsening over time, or who have curvatures leading to nerve compression causing symptoms such as numbness, weakness, or pain.
It can take several months before the patient is feeling normal. This does not mean the patient will not be able to return to a normal life for several months but rather patients continue to steadily improve over the course of several months.
Reviewed by: Dr. Christopher Good, MD, FACS.