Flatback Syndrome



Flatback syndrome is a condition where the spine becomes flat because it loses its natural curvature. The natural shape of the spine isn’t completely straight and has an S-shaped curve. The curves work like a coiled spring to maintain balance, absorb shock, and allow spine movements. As a result of flatback, the lower spine loses its normal curvature and  becomes imbalanced. Thus, the patient might have trouble standing up straight and leaning forward.

Symptoms of flatback

The main symptoms can cause difficulty standing upright and low back and leg pain. What’s more, symptoms may get worse and progress to the point where the patient feels they lean more forward, away from the body and causing trouble in standing upright. This condition has an impact on the patient’s daily task, as patients have to flex and bend their knees and hips to be able to stand upright. This can be often exhausting and result in severe pain. There may be also symptoms of sciatica (pain in the buttocks and leg) and spinal stenosis that are associated.

The flatback syndrome can be a result of any condition that shortens the front part of the spine, such as: Degenerative Disc Disease, Compression Fractures and more.

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Causes of flatback syndrome

Flatback syndrome can be caused by:

  • Degenerative Disc Disease, which occurs with age. As the discs degenerate in the lower back, the lumbar spine becomes stiff and there is loss of normal lordosis (curvature of the spine)
  • Compression fractures of the lumbar vertebral body, often as a consequence of osteoporosis, can lead to loss of lumbar lordosis.
  • Ankylosing Spondylitis – chronic inflammatory arthritic disease involving the spine, causing stiffness and loss of lordosis.
  • Post-Laminectomy Syndrome (failed back syndrome) – flatback can also occur after a surgical procedure, such as a laminectomy, or lumbar spinal fusion. It may lead to loss of lordosis and instability.

Diagnosis of flatback syndrome

There are a number of options available to determine the degree of a flatback syndrome. One of them is an X-ray test with the images of the spine and other bones and tissues. However, first, our orthopedic spine surgeon in Palm Beach County will evaluate your condition, taking into account your history and extent of difficulty standing upright. The history of prior surgery, or other disease that a patient has, plays an important role, as it might be one of the factors predisposing to the syndrome.

The doctor can also order additional diagnostic procedures to collect more information and obtain detailed images of the spine. These include:

  • Magnetic resonance imaging (MRI) scan: helps identify whether the spinal cord has been affected by the spinal curvature.
  • Computed tomography (CT) scan – uses X-rays and a computer to produce detailed images of the body. CT scans are more detailed than general X-rays and provide information about the integrity and health of the discs, vertebrae and patency of the spinal canal.

Treatment options

Flatback syndrome doesn’t always mean back surgery. There are other methods of treating a flatback syndrome, including non-operative treatment. Depending on the condition, patients may be treated with non-operative measures, such as physical therapy, non-steroidal anti-inflammatory medication, posture training and exercise program. These treatment options may provide symptom relief. However, if the structural problem is severe enough and non-operative treatment doesn’t provide relief, then surgery may be required. The aims of surgery are to relieve pain, correct the spine, and prevent the misalignment from getting worse. Our spine expert accomplishes these aims and correct spinal alignment by adding curvature to the lumbar spine.

If you have neck, or lower back pain and symptoms that persist, or worsen, schedule an appointment with our orthopedic spine specialist in Palm Beach County. Our back specialist will evaluate your condition and provide you with an accurate diagnosis.

Dr. Matthew D. Hepler, MD – Further Information

If you have any questions or would like to schedule an appointment with our spine expert, Dr. Matthew Hepler, please contact our Delray Beach office or our Fort Lauderdale office.

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The material contained on this site is for informational purposes only and DOES NOT CONSTITUTE THE PROVIDING OF MEDICAL ADVICE, and is not intended to be a substitute for independent professional medical judgment, advice, diagnosis, or treatment.  Always seek the advice of your physician or other qualified healthcare provider with any questions or concerns you may have regarding your health.