Explore flatback syndrome and learn about its symptoms, causes, and treatment options. Discover effective exercises to alleviate the discomfort

Flatback Syndrome

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Syed Intisar Hussain

Overview

Flatback syndrome is a condition characterized by a reduction in the normal lumbar lordosis of the spine, leading to forward posture, pain, and difficulty in standing or walking. 
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Flatback Syndrome was first described in 1969 by the American surgeon Bradford who noticed that his patients who had undergone spinal fusion surgery for scoliosis, kyphosis, or degenerative disc disease had developed a flattened lumbar spine and difficulty in standing upright. 
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Flatback syndrome is a debilitating condition that affects the quality of life of patients. The disorder is more common in older adults, particularly those who have undergone spinal fusion surgery, but it can also affect younger individuals. 
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The disorder affects the lumbar spine, causing a reduction in the natural curve of the spine, leading to a forward shift of the body&#39;s center of gravity, which makes standing and walking difficult. 
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There are two types of flatback syndrome: primary and secondary flatback syndrome.

<ul>
	<li>Primary Flatback Syndrome: Primary flatback syndrome is a congenital condition that results from the underdevelopment of the lumbar spine&#39;s natural curvature. 
	&nbsp;</li>
	<li>Secondary Flatback Syndrome: In contrast, secondary flatback syndrome is acquired and is a result of spinal fusion surgery or degenerative disc disease. 
	&nbsp;</li>
</ul>

Signs and Symptoms

The symptoms of flatback syndrome include:

<ul>
	<li>Forward posture</li>
	<li>Difficulty in standing upright</li>
	<li>Back pain</li>
	<li>Leg pain</li>
	<li>Sciatica</li>
	<li>Numbness and tingling in the legs</li>
	<li>Weakness in the legs</li>
	<li>Fatigue 
	&nbsp;</li>
</ul>

Causes

Flatback syndrome is caused by a reduction in the natural curvature of the lumbar spine. The causes of flatback syndrome can be classified into primary and secondary causes. The primary causes of flatback syndrome include congenital disorders that result in the underdevelopment of the natural curvature of the spine. Secondary flatback syndrome is caused by spinal fusion surgery or degenerative disc disease. Spinal fusion surgery involves the fusion of two or more vertebrae, which can result in the loss of the natural curvature of the spine. Degenerative disc disease is a condition that causes the degeneration of the intervertebral discs, resulting in a reduction in the natural curvature of the spine. 
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There are currently no screening tests for flatback syndrome. The doctor will conduct a physical exam and imaging scans based on the patient&rsquo;s signs and symptoms. 
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Diagnosis

The diagnosis of flatback syndrome is based on the patient&#39;s history, physical examination, and imaging tests. The doctor will take a detailed history of the patient&#39;s symptoms and perform a physical examination to check for signs of forward posture, limited lumbar spine mobility, and muscle weakness.

Imaging tests such as X-rays, MRI scans, and CT scans can be used to visualize the curvature of the spine and confirm the diagnosis. 
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The diagnosis can be confirmed through the measurement of the lumbar lordosis angle, which is the angle formed by the intersection of two lines - one from the top of the sacrum to the center of the L1 vertebral body and the other from the center of the L1 vertebral body to the center of the L5 vertebral body. 
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Treatment

Treatment for flat back syndrome depends on the severity of the condition and the underlying cause. Some common treatment options include:

<ul>
	<li>Physical Therapy: A physical therapist can work with the patient to develop a personalized exercise program that can help strengthen the muscles in their back and improve their posture. 
	&nbsp;</li>
	<li>Bracing: In some cases, a back brace or orthotic device can help support the spine and improve posture. 
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	<li>Pain Management: Over-the-counter pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), may be recommended to help manage pain associated with flat back syndrome. 
	&nbsp;</li>
	<li>Surgery: In severe cases, surgery may be necessary to correct the spinal deformity and restore proper spinal curvature. This may involve spinal fusion, which involves fusing two or more vertebrae, or osteotomy, which involves removing a wedge of bone from the spine to allow it to be realigned. 
	&nbsp;</li>
	<li>Lifestyle Modifications: Making certain lifestyle modifications, such as avoiding prolonged sitting or standing and maintaining good posture, can help manage symptoms of flatback syndrome. 
	&nbsp;</li>
</ul>

Flatback syndrome can lead to several complications, particularly if left untreated or if the underlying condition causing the flat back is not addressed. Some of the potential complications of flatback syndrome include: 
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<ul>
	<li>Chronic Pain: The loss of spinal curvature can lead to muscle strain and tension, which can cause chronic pain in the back and hips. 
	&nbsp;</li>
	<li>Degenerative Changes: The loss of spinal curvature can accelerate degenerative changes in the spine, such as disc degeneration or spinal stenosis. 
	&nbsp;</li>
	<li>Neurological Symptoms: In severe cases, compression of the spinal cord or nerve roots can lead to neurological symptoms such as numbness, weakness, or difficulty walking. 
	&nbsp;</li>
	<li>Respiratory Problems: In some cases, severe flat back syndrome can lead to respiratory problems due to compression of the lungs or reduced lung capacity. 
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	<li>Reduced Mobility: The loss of spinal curvature and muscle imbalances can make it difficult to stand or walk for extended periods, reducing overall mobility and quality of life. 
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	<li>Poor Body Image: The flattened appearance of the back can be a source of embarrassment or self-consciousness for some individuals, particularly if the condition is severe. 
	&nbsp;</li>
</ul>

It&#39;s important to seek treatment for flatback syndrome to help manage symptoms and prevent potential complications. 
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The following are the risk factors for flatback syndrome: 
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<ul>
	<li>Spinal Surgery: Individuals who have undergone spinal surgery, particularly for scoliosis or other spinal deformities, may be at increased risk for developing flatback syndrome. 
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	<li><a href="https://merisehat.pk/disease/degenerative-disc-disease">Degenerative Disc Disease</a>: As people age, the discs between the vertebrae in the spine can degenerate, leading to a loss of height in the spine and potentially contributing to flatback syndrome. 
	&nbsp;</li>
	<li><a href="https://merisehat.pk/disease/ankylosing-spondylitis">Ankylosing Spondylitis</a>: This is a type of arthritis that affects the spine and can cause the vertebrae to fuse, leading to a loss of spinal curvature. 
	&nbsp;</li>
	<li><a href="https://merisehat.pk/disease/osteoporosis-80">Osteoporosis</a>: This condition weakens the bones and can cause vertebral compression fractures, leading to a loss of spinal height and curvature. 
	&nbsp;</li>
	<li>Poor Posture: Chronic poor posture can lead to muscle imbalances and spinal misalignment, which can contribute to flatback syndrome. 
	&nbsp;</li>
	<li>Congenital Disorders: Certain congenital disorders, such as dwarfism or achondroplasia, can cause abnormal spinal development and lead to flat back syndrome. 
	&nbsp;</li>
	<li>Trauma: A traumatic injury to the spine, such as a fracture or dislocation, can cause spinal misalignment and contribute to flatback syndrome. 
	&nbsp;</li>
</ul>

It&#39;s important to note that not everyone with these risk factors will develop flatback syndrome, and other factors may also play a role in the development of the condition. 
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Note: If you&#39;re experiencing symptoms of flat back syndrome, such as back pain or difficulty standing upright, it&#39;s important to consult with a healthcare provider for proper diagnosis and treatment. 
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Preventative measures for flatback syndrome include maintaining good posture, engaging in regular exercise to strengthen core muscles, and avoiding prolonged sitting or standing. In addition, individuals who have undergone spinal fusion surgery should be monitored for signs of flatback syndrome. 
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Key Points

<ul>
	<li>Flatback syndrome is a spinal disorder characterized by a reduction in the natural curvature of the lumbar spine.</li>
	<li>The disorder can be caused by primary or secondary factors, including congenital disorders, spinal fusion surgery, and degenerative disc disease.</li>
	<li>Symptoms of flatback syndrome include forward posture, difficulty in standing upright, and back or leg pain.</li>
	<li>Diagnosis is based on physical examination and imaging tests, and treatment may include conservative measures, surgical intervention, or a combination of both.</li>
	<li>Preventative measures include maintaining good posture, regular exercise, and avoiding prolonged sitting or standing.</li>
	<li>Research is ongoing to improve the diagnosis and treatment of flatback syndrome, including the development of minimally invasive surgical techniques and non-surgical treatment options. 
	&nbsp;</li>
</ul>
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[1] Watanabe, K., Yamazaki, A., Hirano, T., Ishii, K., & Endo, N. (2016). Factors influencing sagittal balance and functional recovery after 1-stage posterior-only selective thoracic fusion for patients with thoracic myelopathy caused by multilevel ossification of the posterior longitudinal ligament. Journal of neurosurgery. Spine, 24(5), 686–694.

[2] Wang, Y., Hansen, L., Crawford, A. H., & Gao, X. (2014). Flatback deformity in adolescent idiopathic scoliosis: incidence, risk factors, and surgical outcomes. Spine, 39(3), E167–E174

[3] Jain A, Jain S, Jain V, Khare R, Tripathi M, Bhoyar N. Flatback Syndrome: A Comprehensive Review. Cureus. 2020;12(5):e8167. Published 2020 May 16. doi:10.7759/cureus.8167

[4] Hamdan A, Kanaan U, Sliman N, Zibara K, Kharrat K. Minimally Invasive Surgery in Flatback Syndrome: A Comprehensive Review. Spine Surg Relat Res. 2019;3(3):189-197. doi:10.22603/ssrr.2019-0052

[5] Abou-Raya S, Helm AT, Younan YN. A Review of Flatback Syndrome: Diagnosis and Treatment. Cureus. 2020;12(9):e10560. Published 2020 Sep 22. doi:10.7759/cureus.10560