Back Pain

What is Flatback Syndrome?

Flatback Syndrome
Flatback Syndrome as the name indicates is a postural defect of the back characterized by difficulty in standing upright due to the reduction or absence of ˜sway’ in the lower back or lordosis. A deformity of the spine in the sagittal plane, this condition is a result of the outward pushing of the intervertebral discs in a person’s back which in turn decreases the backwaist curve making the back appear flatter than its original shape.

Spinal Curves:

The basic structure of spine contains 2 curves, which help neck, arms and trunk in balancing the weight. At the chest level, the spine curves in a forward manner, where the ribs meet the spine. This spinal curvature is known as kyphosis. Backward curvature of spine, where the lower back and pelvis join is known as lordosis.

Flatback Syndrome

is a result of either kyphosis or lordosis or both which make the spine appear straight (flat). People suffering from this condition appear stooped forward and struggle to stand straight. Moreover, they experience back pain and difficulty in standing erect.


  • In most of the cases, this spinal deformity was seen after scoliosis (abnormal spinal curvature) was corrected. The rods used during this procedure to straighten the abnormal curvature tend to straighten the original spinal curves.
  • Spinal fusion surgery or arthritis of the spine may also result in this condition.

Symptoms of Flatback Syndorme:

Apart from the strange back appearance, people suffering from this condition may also experience:

  • Patients with severe deformity may have to use a walker or stick that provides assistance while walking. This is required to support the body weight that is not centered over the pelvic region and legs. This may lead to unbearable pain and discomfort.
  • Chronic pain in the muscles of the back.
  • Sensation of falling forward.
  • Stooping by the end of the day.
  • Difficulty in performing certain daily activities.
  • Patients will have to flex their knees in order to stand straight.
  • Pain is experienced in the upper back and is often described as a fatigue-type.
  • Lower neck pain is another common symptom.
  • Patients struggle to see straight ahead and usually have to hyperextend their necks for proper visibility which can lead to pain in the neck region and muscle fatigue.

Diagnosis of Flatback Syndrome:

Patients with deformities in the sagittal plane are often recommended to get a standing, full-length (36 inches) lateral radiograph of the entire spine done. In this diagnostic test, the patient is instructed to stand with both the knees fully extended.

Other radiographs such as hyperextension radiographs that assess the flexibility. MRI or CT scan to evaluate the spinal canal, oblique radiographs that detect pseudarthroses (result of a failed attempted spinal fusion) might be needed if the patient needs surgical intervention.

Treatment of Flatback Syndrome: 

Nonsurgical –Patients with mild deformity can benefit from this option. Physical therapy that involves spinal extension exercises, hip extension exercises and non steroidal anti inflammatory drugs that help in relieving the pain are recommended.

Surgical – Patients who do not benefit from the above nonsurgical options are left with the only alternative of surgery. The main aim of performing a surgery is to restore the spinal curvature and eliminate back pain.

Surgical correction of this syndrome and may other sagittal plane deformities usually involves one or more closing wedge osteotomies (removal of a wedge of a bone).

Surgical strategy has to be individualized depending on the severity of the affected area. The main aim is to achieve complete rebalancing of the spine.

Fortunately this syndrome can be prevented. Appropriate back positioning and avoiding insertion of instruments into the lower back of the spine (may be required for patients suffering from scoliosis) are the best ways to prevent it.

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