Flatback Syndrome

Understanding Flatback Syndrome (FBS)

What Is Flatback Syndrome?

Flatback Syndrome (FBS) is a spinal deformity where the natural lumbar curvature of the spine (the lordotic curve) is reduced or becomes flat. The lumbar spine normally has a slight inward curve, which helps distribute the body’s weight and provides flexibility. However, when this curvature is reduced or lost, it can result in a forward-leaning posture, which may cause significant pain and functional limitations.

Causes of Flatback Syndrome

There are several potential causes of Flatback Syndrome:

  1. Degenerative changes: As we age, natural wear and tear on the discs and joints of the spine can lead to a loss of the lumbar curve.
  2. Ankylosing spondylitis: A type of arthritis that affects the spine, causing vertebrae to fuse together, can reduce spinal flexibility.
  3. Iatrogenic causes: Some surgeries, especially those from the earlier era of spinal fusions for scoliosis, used instrumentation and techniques that led to a flat lumbar spine over time.
  4. Osteoporosis: This bone-weakening disease can lead to compression fractures, which can reduce the lumbar curve.
  5. Trauma: Injuries to the spine can sometimes result in Flatback Syndrome.

Symptoms of Flatback Syndrome

The most common symptom of Flatback Syndrome is chronic pain in the lower back. This is often accompanied by fatigue, especially when standing for prolonged periods. Individuals may also find themselves leaning forward to find a more comfortable position or need to bend their knees to achieve an upright posture.

Other symptoms can include:

  • Leg pain or sciatica
  • Difficulty standing upright
  • A tendency to walk with a forward lean
  • Difficulty looking straight ahead without straining the neck

Treatment Options for Flatback Syndrome

Surgical intervention may be considered when conservative treatments, such as physical therapy and pain management, fail to provide relief. The primary goal of surgery is to correct the spinal alignment, relieve pain, and restore function.

  1. Spinal Osteotomy: This procedure involves removing a wedge-shaped portion of the vertebral bone to correct the spine’s alignment. The remaining bone is then realigned and stabilized using screws, rods, or plates.
  2. Pedicle Subtraction Osteotomy (PSO): This type of spinal osteotomy is where a section of the vertebra (the pedicle) is removed to create a bend in the spine, restoring some of the lost lumbar curves.
  3. Vertebral Column Resection (VCR): In this procedure, one or more entire vertebrae are removed, allowing the surgeon to realign the spine significantly. It’s often reserved for severe cases.
  4. Extension of Previous Fusion: If the patient had a prior fusion that led to Flatback Syndrome, the surgeon might extend the fusion to include more of the spine, realigning the segments to restore a more natural curve.
  5. Anterior Lumbar Interbody Fusion (ALIF): The surgeon accesses the lumbar spine from the front (anterior) and places a bone graft or cage between the vertebrae, restoring some lost disc height and lumbar curvature.

Rehabilitation After Surgery

After undergoing surgery for Flatback Syndrome, a comprehensive rehabilitation plan is vital for optimal recovery and outcomes.

  1. Immediate Post-operative Care: This often involves monitoring in a hospital setting for a few days to ensure there aren’t any complications from the surgery. Pain management is crucial during this phase, and measures are taken to ensure the patient is as comfortable as possible.
  2. Physical Therapy: As the patient recovers, physical therapy will play an essential role in regaining strength and mobility. A physical therapist will work with the patient on specific exercises to strengthen the core and back muscles, improve flexibility, and enhance posture.
  3. Bracing: Some patients may be prescribed a back brace to provide additional support and limit motion while the spine heals. The duration for which the brace needs to be worn can vary based on the type of surgery and individual factors.
  4. Lifestyle Modifications: Maintaining a healthy weight, practicing good posture, and engaging in regular, low-impact exercise can help ensure the long-term success of the surgery and reduce the chances of future spinal problems.
  5. Regular Follow-ups: Periodic check-ups with the spine surgeon are crucial to monitor the healing process and ensure that the spine is aligning properly. Imaging tests like X-rays or MRIs might be used to assess the results of the surgery.

Surgical Considerations

While modern surgical techniques and experienced surgeons have significantly reduced the risks associated with spine surgery, some potential complications include:

  • Infection at the surgical site
  • Blood clots
  • Nerve damage leading to numbness, tingling, or weakness
  • Non-union or failure of the spine to fuse
  • Hardware malfunction or breakage
  • Continued or recurrent pain

Given spinal surgery’s complexity, choosing a surgeon with specialized training and considerable experience in treating Flatback Syndrome is crucial. Seeking second opinions, reading reviews, and checking a surgeon’s credentials can all aid in making an informed decision.

Flatback Syndrome can significantly impact an individual’s quality of life. While conservative treatments are always the first line of defense, surgical options are available for those who do not find relief. With appropriate surgical intervention followed by comprehensive rehabilitation, many patients can return to a more comfortable and active lifestyle. However, as with any medical procedure, it’s important to be well-informed, set realistic expectations, and actively participate in recovery for the best outcomes. As with any surgery, there are risks, and discussing potential benefits and drawbacks with a qualified spine surgeon is essential. 

For a comprehensive evaluation and to explore your treatment options, don’t hesitate to schedule an appointment or seek a second opinion consultation with Dr. Scott Raffa at Cantor Spine Center at the Paley Orthopedic & Spine Center by calling 561-935-1188. Take the first step towards a pain-free life by calling us today.