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Thoracic Flat Back Syndrome

What is a “Flat Back Syndrome”?

Normally, the spine has an S-Shaped curve when looking at an X-Ray taken from the side. A thoracic “flat back syndrome” is a spine condition where the normal thoracic curve (kyphosis) is flattened. Instead of having a forward curvature (kyphosis) in the mid-back, patients lose the curvature and have a straight mid 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 thoracic flat back syndrome, the line falls to the back of the sacrum. This means the weight of the body is located behindthe mid-back rather than in-line with it.

Why does a Thoracic Flat Back Syndrome cause problems?

A flat back syndrome creates the feeling of leaning backward or being bent backward. Patients often have to try to compensate by keeping their legs and hips straight which can cause chronic spine, hip and leg pain.

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.
  3. Feeling of falling backwards
  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.

      2. CT Scan

A CT scan can help to see the bone anatomy of the mid-back. It can show a flat back and the cause of it.

       3. MRI

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

How is a Thoracic Flat Back Syndrome treated?

Patients with a thoracic 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 a Thoracic Flat Back Syndrome.

B. Chiropractic Care

Conventional chiropractic manipulation may be difficult to perform for this condition since the thoracic spine is fused and does not move. However, the segments of the spine above and below the fusion may benefit from chiropractic adjustments.

C. Spine Exercises

Maintaining good muscle tone of the mid-back muscles can help with the pain from a Flat Back Syndrome. It is often these muscles which are tender and contribute to the patient’s symptoms.

D. Physical Therapy (PT)

Isometric strengthening exercises of the spine are just one example of PT exercises which can help this condition.

E. Self Help Devices

Self Help Devices such as Back Support Mattresses and Spine Pillows can help patients suffering from this condition.

F. Medications

Here are some groups of medications which can help this condition:

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

F. Weight loss

Patients who are overweight can improve their function and symptoms through weight loss. Weight loss can remove some of the strain from the mid-back.

G. Injections

Here are some injections which can help patients with this condition:

  1. Thoracic Trigger Point Injections
  2. Thoracic Muscle Blocks
  3. Thoracic Epidural Steroid Injections (above or below the fusion)
  4. Thoracic Facet Joint Injections (above or below the fusion)
  5. Thoracic Facet Joint Radiofrequency Rhizotomy (above or below the fusion)
  6. Thoracic Spinal Cord Stimulation
  7. Lumbar Intrathecal Pain Pump Implantation


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. This is called an Osteotomy. The spine has to be fused again with the new curvature.

Here is a surgical option sometimes done for this condition:

Thoracic Osteotomy and Fusion