Flatback syndrome is a specific type of spinal deformity where the lumbar spine, or the lower spine, loses its natural inward curve known as lordosis. This condition leads to a sagittal imbalance, which means an imbalance in the front-to-back alignment of the spine.
The spine, under typical conditions, boasts several gentle curves front-to-back. When these curves alter or flatten, conditions like flatback syndrome arise, and it can have a direct impact on an individual’s posture. If the deformities in the sagittal plane are significant, they can prevent a person from achieving an upright posture with the head aligned over the hips, resulting in what’s known as sagittal imbalance.
Flatback syndrome can develop due to various reasons, but a notable cause is failed spine surgery. Specifically, spinal fusions performed for degenerative spine conditions aim to decompress the neural elements, stabilize, and fuse the pain-generating levels of the spine, and restore optimal biomechanical alignment. If the outcome is not as desired, it can lead to this syndrome. One such case was a young patient who, after a lumbar fusion surgery, developed flatback syndrome. They were unable to walk upright or stand due to the disabling pain. However, two years post-op, the patient showed remarkable improvement, with the ability to stand upright and even returned to full-time work.
Furthermore, it’s worth noting that adult scoliosis, another spinal deformity, shares some symptoms with flatback syndrome. The most common symptom of scoliosis in adults is pain, often accompanied by a visible bulge on the back. Some may also experience fatigue, a perceived loss of height, or an unusual feeling of fullness when the stomach is empty. Patients with degenerative scoliosis typically experience pain or symptoms in the back, hip, buttocks, or legs.
While many times back pain can resolve on its own, it’s crucial to seek medical attention if experiencing ‘red flag’ symptoms, such as fever or a loss of bowel or bladder control. In the early stages, applying ice can help numb the pain and reduce swelling.
There are surgical treatments available for addressing sagittal imbalance. One such option is pedicle subtraction osteotomy, which is designed to correct conditions like hyperkyphosis, ankylosing spondylitis, and flatback syndrome, which can shift the body’s center of gravity too far ahead of the pelvis.
For those considering back surgery, it’s essential to weigh the benefits against the risks and ensure it’s the right choice for their unique situation.
