Non-operative correction of flat back syndrome using lumbar extension traction: a CBP^® case series of two

[Purpose] To document the non-operative rehabilitation of lumbar lordosis in two cases with chronic low back pain and flexible flat back syndrome. [Participants and Methods] Two young adult males reported suffering from chronic low back pain associated with anterior sagittal balance and severe loss of lumbar lordosis, aka 'flat back syndrome.' Lumbar extension traction was applied 3-5 times per week for 16.5-20 weeks. A torsion type lumbar spinal manipulative therapy was provided in the initial 3 weeks for short-term pain relief. [Results] Both patients had dramatic improvement in lumbar lordosis with simultaneous reduction in pain levels. One patient had a 50° lordosis improvement in 100 treatments over 20 weeks; the other had a 26° lordosis improvement in 70 treatments over 16.5 weeks. There were also improvements in sacral base angle, pelvic tilt and sagittal balance. One patient demonstrated stability of health status and further improvements in radiographic measures including lordosis angle nearly 10-months post-treatment. [Conclusion] This is the first successful non-operative correction of flat back syndrome. This approach seems highly effective, is a fraction of the cost of spinal surgery typically used to treat this condition, and offers no health risks including those assumed from radiography necessary for screening and follow-up.