An individual with flatback syndrome does not have the normal curvature in their lumbar, or lower, spine. This normal inward curve is called lordosis. It balances the slightly outward curvature of the middle spine and the lordosis of the cervical spine, or neck. These normal curvatures keep the body’s center of gravity over the hips and pelvis. Flatback syndrome occurs when the lower curvature is lost.
Symptoms of flatback syndrome
The individual with flatback syndrome has noticeable difficulty standing upright. The imbalance of their spine causes the head to lean forward, which becomes more pronounced over time. The person may try to compensate by tilting their pelvis or flexing their hips and knees. This often results in chronic pain and fatigue in the back muscles. Flatback syndrome can cause difficulty in performing certain daily activities, as the person has the sensation of falling forward. By the end of the day, they may be very stooped over or have difficulty standing for long periods. They may need a cane or walker to provide stability.
Causes and risk factors
Flatback syndrome may be the result of arthritis of the spine or degenerative disc disease. Compression fractures and ankylosing spondylitis are other causes. Spinal fusion surgery that does not maintain the normal curvature of the low back may result in flatback syndrome. Some patients developed flatback syndrome after having previous scoliosis treatments with rods. Current scoliosis treatments decrease the risk of developing flatback syndrome.
The physician will perform a thorough physical examination along with patient history. X-rays of the spine will show overall spinal alignment. The doctor may also order a CT scan for more detailed images of the spine.
Treatment of flatback syndrome
Treatment options depend on the cause of flatback syndrome and the degree to which it has progressed.
- Non-surgical treatments – Conservative treatments may include physical therapy exercises for core muscle strengthening and posture training. Medications or spinal injections can be used to manage pain symptoms.
- Surgical treatments – When the misalignment is severe, surgery may be necessary for spinal stability. The surgical goal is to add curvature to the lumbar spine, prevent the misalignment from worsening, and to relieve pain. Surgical procedures can include osteotomy and pedicle subtraction osteotomy.