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Lumbar Flat Back Syndrome

What is a Lumbar Flat Back Syndrome?

Normally, the spine has an S-Shaped curve when looking at an X-Ray taken from the side. A lumbar “flat back syndrome” is a spine condition where the normal lumbar curve (lordosis) is flattened. Instead of having a backward curvature (lordosis) in the low back, patients lose the curvature and have a straight low back.

How is a Flat Back Syndrome determined?

Normally, a line can be drawn through the spine from the skull to the tailbone (plumb line). This line should intersect the first segment of the tailbone (S-1 vertebra). In a flat back syndrome, the line falls to the front of the sacrum. This means the weight of the body is located in front of the low-back rather than in-line with it.

Why does a Flat Back Syndrome cause problems?

A flat back syndrome creates the feeling of leaning forward or being bent over. Patients often have to bend the knees and hips to create a more upright posture. This can result in pain in the spine and legs as they are chronically trying to compensate for the forward bent posture.

Why does a Flat Back Syndrome happen?

Flat back syndrome can occur in the mid (thoracic spine) and low back (lumbar spine). It is most commonly a result of spinal fusion [link] surgery, where the metal hardware such as the titanium rods failed to recreate a patient’s normal spine curvature.

During a fusion surgery, titanium screws and rods are placed into the spine to connect the vertebrae and allow them to fuse together. However, the surgeon often has to bend the rods so that they have the same curvature as the rest of the low-back. This can sometimes be difficult to do, which leaves the spine with a fusion which has a very flat curvature or none at all.

What symptoms does Flat Back Syndrome cause?

Here are some of the common symptoms of flat back syndrome:

  1. Spine pain in the neck (cervical), mid-back (thoracic) and low-back (lumbar)
  2. Pain and tightness in the buttocks and thighs, especially the front of the thighs.
  3. Feeling of slumping or falling forward
  4. Difficulty walking on uneven ground
  5. Tripping easily

How is Flat Back Syndrome diagnosed?

The diagnosis of flat back syndrome is commonly made with spine X-Rays.

  1. X-Rays

A standing X-Ray taken from the front and the side is preferred showing the full length of the spine (scoliosis film). This X-Ray will show the spinal curvatures well. The curves can then be measured and a diagnosis of flat back syndrome can be made. This is usually the test of choice.

       2. CT Scan

A CT scan can help to see the bone anatomy of the low back. It can show a flat back and the cause of it. However, it is typically not needed for the diagnosis and carries significant radiation exposure to the patient.

       3. MRI

MRI scans can show a flat back syndrome. However, MRI scans are not as good as CT Scans or X-Rays about showing the details of the anatomy of the lumbar vertebrae.

How is a Lumbar Flat Back Syndrome treated?

Patients with a lumbar flat back syndrome may not have noticeable symptoms. However, here are some treatment options for the ones who do:

  1. Nonsurgical Care

A. Alternative Health Care

Alternative Health care options can often complement conventional medical care. Massage Therapy, Acupuncture, Meditation exercises and Herbal Remedies can all help with the pain from this condition.

B. Nutrition and Weight Loss

Proper nutrition and weight loss can have a positive impact on many spine conditions. Excess weight on the spine often contributes to the symptoms of pain and spasms.

C. Chiropractic Care

Chiropractic care including manipulation and adjustments of the spine can help with the pain and spasms from this condition.

D. Spine Exercises

Spine exercises can help with the muscle pain and tightness from this condition. Exercise also increases the amount of oxygen delivered to the spine which can help with healing. Pilates, Yoga and T’ai Chi can help maintain the spine’s flexibility.

E. Physical Therapy (PT)

PT has many modalities to offer for this condition. They can range from Manual Therapy and Exercises to Traction and Ultrasound Treatments. Isometric strengthening exercises are one of the modalities can help.

F. Self Help Tools

Self Help Tools are items which can be purchased to help with back pain. They range from Back Braces to Back Mattresses and Ergonomic Devices such as chairs and computer accessories.

G. Spine Medications

Here are some of the common groups of medications which are available for this condition:

  1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)
  2. Muscle Relaxants
  3. Pain Killers
  4. Nerve Pain Medications
  5. Antidepressants
  6. Topical Medications


H. Injections

Some injections can help with the muscle pain common in Flat Back Syndrome.

  1. Trigger Point Injections
  2. Muscle Blocks
  3. Caudal Epidural Injections


     2. Surgical Care

The surgical treatment of flat back syndrome is reserved for patients with severe pain and a poor quality of life.

If the flat back syndrome is a consequence of a fusion surgery, the corrective surgery can be challenging. Often, the fused vertebrae have to be cut into and made into wedges to change the curvature. The spine has to fused again with the new curvature.

Here is a surgical option sometimes done for this condition: Lumbar Osteotomy and Fusion.