In my practice as a Spine physician, I see a variety of injuries and illnesses in my office every day which pertain to the spine, back and neck. An interesting condition that I sometimes treat is that of a patient whose spine has lost its natural curvature in the lumbar region, usually arising from another problem in the spine. In this article, I will discuss flat back syndrome, its causes, symptoms and how we treat this disorder.
I don’t know if you’ve ever really looked at a human skeleton, but from the side, you can see that the spine has four natural curves, two being lordotic and two being kyphotic, kind of like a shallow “S” shape. These spinal curves help to balance the weight of the head perfectly over the hips and allow the body to walk upright in correct alignment. When the lower back loses its lordotic curve and becomes flattened, the brain will try to compensate for balance and will start leaning the patient forward, little by little, over time, as the back becomes flatter. The patient probably won’t notice at first, but as the condition progresses, their pelvis will also tilt, and their head will drop forward as the brain continues to try to balance the body. As the patient’s muscles tighten, they will find it harder to stand up straight without pain, often in their neck, lower back and legs. They often present with a somewhat hunched over appearance with their knees slightly bent, due to this disorder.
Flat Back Syndrome can occur idiopathically (we don’t know the cause), but more often, there is an underlying reason. The most common are:
- Ankylosing Spondylitis – a chronic auto-inflammatory condition that affects the spine
- Degenerative Disc Disease – typical wear and tear, age-related process where the spinal discs lose water, flatten and don’t provide cushion and shock absorption for the vertebrae
- Vertebral compression fractures – these usually happen as we age, and our bones become more fragile
- Post Lumbar Laminectomy Syndrome – After having surgery to relieve spinal stenosis where a part of the spinal lamina is removed, the lumbar spine may become unstable
- Post scoliosis surgery syndrome – not a common now, but used to be after large scoliosis surgeries where rods were used to straighten the spine
I diagnose patients by doing a very thorough physical examination, taking x-rays, and asking them lots of questions about their medical history, lifestyle, activities, when they started having problems, etc. I may also order an MRI to look for underlying causes for flat back syndrome once I have determined that the patient indeed has it. I will need to address that underlying cause in order to correct the problem, if at all possible.
I will typically order Physical Therapy at first to address postural changes, lack of strength and flexibility issues. I may prescribe anti-inflammatory medications or muscle relaxants to help reduce pain while giving the physical therapy an opportunity to work. Rest, alternating ice and heat, behavior modification, bracing, and an at home exercise regimen are all great ways to address flat back syndrome conservatively.
Should the patient’s MRI return with signs of something that needs more aggressive treatment, there are a variety of options to choose from, including epidural steroid injections, kyphoplasty for vertebral fractures, and other in-office procedures. These are done without anesthesia and are very successful at relieving pain for many patients.
For those major spine issues that require surgical attention, I will address those individually with the patient. Today’s spine surgeries are minimally invasive, mostly outpatient or one-night stay procedures that can address almost every spine condition. There are so many treatment options available to us now, that I can help my patients find exactly the right therapy, whether it be surgery, pain management or conservative care, that works for them and the way they want to live.
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