What Are the Surgical Treatments for Flatback Syndrome and Lordosis?

Procedures such as osteotomy and pedicle subtraction osteotomy are utilized to treat Flatback syndrome, a spinal deformity characterized by a loss of the lumbar spine’s normal lordosis. During these procedures, a surgeon removes a portion of bone from the lumbar spinal column’s posterior to allow for the realignment of the spinal column and the reintroduction of the necessary lordosis. Lordosis, especially in its excessive form known as hyperlordosis, refers to an abnormal inward curvature of the lower back, which may develop to compensate for hyperkyphosis located elsewhere in the spine.

Diagnosing lordosis generally starts with an X-ray and can include advanced imaging such as MRI or CT scans if necessary. Treatment focuses on the cause and the symptoms experienced by the patient, often involving medications for neck or back discomfort control. The treatment aims to prevent the worsening of the curvature and the development of further deformity. This treatment may involve observation, regular exams, and varies depending on the cause and the amount of growth remaining in a child.

The spine comprises several curves; the cervical spine has a gentle lordosis, the thoracic spine a gentle kyphosis, and the lumbar spine again presents a gentle lordosis. The lumbar region is of particular interest when correcting Flatback syndrome since the issue usually stems from insufficient lumbar lordosis or excessive thoracic kyphosis. Surgical planning often involves adding lordosis, reducing kyphosis, or both, typically achieved through osteotomy procedures.

For more information on spinal deformities and treatments, refer to Columbia Neurosurgery. Additionally, details on lordosis can be found at the UConn Health website, the University of Rochester Medical Center, the Children’s Hospital of Philadelphia, and the Washington University Orthopedics. For more on deformity correction and stabilization, visit Columbia Neurosurgery, and for insights into sagittal imbalance, explore Columbia Neurosurgery’s sagittal imbalance page.