Iatrogenic Flatback and Flatback Syndrome: Evaluation, Management, and Prevention

Area of Science:

• Spine surgery
• Orthopedics
• Spinal deformity correction

Background:

• Flatback syndrome causes significant disability, impacting stance, gait, and pain.
• Iatrogenic flatback can result from both historical and modern spinal instrumentation.
• Patients compensate through adjacent segment lordosis and reduced thoracic kyphosis, eventually leading to sagittal imbalance.

Purpose of the Study:

• To review the pathophysiology and management of flatback syndrome.
• To highlight the challenges in maintaining sagittal balance.
• To discuss the efficacy of surgical interventions.

Main Methods:

• Review of literature on flatback syndrome and thoracolumbar fusion.
• Analysis of compensatory mechanisms in sagittal balance.
• Evaluation of nonoperative and operative treatment outcomes.

Main Results:

• Nonoperative management is often unsuccessful for sagittally imbalanced flatback syndrome.
• Surgical correction can restore lumbar lordosis and improve sagittal balance.
• Surgical intervention can significantly enhance patient quality of life.

Conclusions:

• Flatback syndrome is a debilitating condition with complex compensatory mechanisms.
• Surgical management, including interbody fusions and osteotomies, offers significant benefits for quality of life.
• Careful instrumentation selection and application are crucial to prevent iatrogenic flatback.