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Flat Back Syndrome
Lubdha M. Shah, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Abbreviations

            • Flat back syndrome (FBS)
          • Synonyms

            • Fixed Sagittal Imbalance (FSI), iatrogenic flat back syndrome/deformity, abnormal spinal kyphosis
          • Definitions

            • Loss of lumbar lordosis (LL) after scoliosis or lower lumbar distraction instrumentation, vertebral fracture, ankylosing spondylitis, or degenerative disease
              • Sagittal imbalance with center of gravity of head anterior to sacrum

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      CLINICAL ISSUES

                      • Presentation

                        • Natural History & Prognosis

                          • Treatment

                            DIAGNOSTIC CHECKLIST

                            • Reporting Tips

                              Selected References

                              1. Boissière L et al: Lumbo-pelvic related indexes: impact on adult spinal deformity surgery. Eur Spine J. ePub, 2014
                              2. Vital JM et al: Osteotomies through a fusion mass in the lumbar spine. Eur Spine J. ePub, 2014
                              3. Weisz GM et al: Scanogram for sagittal imbalance of the spine: low dose alternative for a safer diagnosis. Curr Rheumatol Rev. 10(1):35-7, 2014
                              4. Hedlund R: Pedicle subtraction osteotomy in flat back syndrome 38 years after Harrington instrumentation for AIS. Eur Spine J. 21(3):563-5, 2012
                              5. Jagannathan J et al: Iatrogenic spinal deformity. Neurosurgery. 63(3 Suppl):104-16, 2008
                              6. Potter BK et al: Prevention and management of iatrogenic flatback deformity. J Bone Joint Surg Am. 86-A(8):1793-808, 2004
                              7. Wiggins GC et al: Management of iatrogenic flat-back syndrome. Neurosurg Focus. 15(3):E8, 2003
                              8. Danisa OA et al: Surgical correction of lumbar kyphotic deformity: posterior reduction "eggshell" osteotomy. J Neurosurg. 92(1 Suppl):50-6, 2000
                              9. Umehara S et al: The biomechanical effect of postoperative hypolordosis in instrumented lumbar fusion on instrumented and adjacent spinal segments. Spine (Phila Pa 1976). 25(13):1617-24, 2000
                              10. Booth KC et al: Complications and predictive factors for the successful treatment of flatback deformity (fixed sagittal imbalance). Spine (Phila Pa 1976). 24(16):1712-20, 1999
                              11. Lin RM et al: Lumbar lordosis: normal adults. J Formos Med Assoc. 91(3):329-33, 1992
                              12. La Grone MO: Loss of lumbar lordosis. A complication of spinal fusion for scoliosis. Orthop Clin North Am. 19(2):383-93, 1988
                              Related Anatomy
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                              Related Differential Diagnoses
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                              References
                              Tables

                              Tables

                              KEY FACTS

                              • Terminology

                                • Imaging

                                  • Clinical Issues

                                    • Diagnostic Checklist

                                      TERMINOLOGY

                                      • Abbreviations

                                        • Flat back syndrome (FBS)
                                      • Synonyms

                                        • Fixed Sagittal Imbalance (FSI), iatrogenic flat back syndrome/deformity, abnormal spinal kyphosis
                                      • Definitions

                                        • Loss of lumbar lordosis (LL) after scoliosis or lower lumbar distraction instrumentation, vertebral fracture, ankylosing spondylitis, or degenerative disease
                                          • Sagittal imbalance with center of gravity of head anterior to sacrum

                                      IMAGING

                                      • General Features

                                        • Radiographic Findings

                                          • CT Findings

                                            • MR Findings

                                              • Imaging Recommendations

                                                DIFFERENTIAL DIAGNOSIS

                                                  CLINICAL ISSUES

                                                  • Presentation

                                                    • Natural History & Prognosis

                                                      • Treatment

                                                        DIAGNOSTIC CHECKLIST

                                                        • Reporting Tips

                                                          Selected References

                                                          1. Boissière L et al: Lumbo-pelvic related indexes: impact on adult spinal deformity surgery. Eur Spine J. ePub, 2014
                                                          2. Vital JM et al: Osteotomies through a fusion mass in the lumbar spine. Eur Spine J. ePub, 2014
                                                          3. Weisz GM et al: Scanogram for sagittal imbalance of the spine: low dose alternative for a safer diagnosis. Curr Rheumatol Rev. 10(1):35-7, 2014
                                                          4. Hedlund R: Pedicle subtraction osteotomy in flat back syndrome 38 years after Harrington instrumentation for AIS. Eur Spine J. 21(3):563-5, 2012
                                                          5. Jagannathan J et al: Iatrogenic spinal deformity. Neurosurgery. 63(3 Suppl):104-16, 2008
                                                          6. Potter BK et al: Prevention and management of iatrogenic flatback deformity. J Bone Joint Surg Am. 86-A(8):1793-808, 2004
                                                          7. Wiggins GC et al: Management of iatrogenic flat-back syndrome. Neurosurg Focus. 15(3):E8, 2003
                                                          8. Danisa OA et al: Surgical correction of lumbar kyphotic deformity: posterior reduction "eggshell" osteotomy. J Neurosurg. 92(1 Suppl):50-6, 2000
                                                          9. Umehara S et al: The biomechanical effect of postoperative hypolordosis in instrumented lumbar fusion on instrumented and adjacent spinal segments. Spine (Phila Pa 1976). 25(13):1617-24, 2000
                                                          10. Booth KC et al: Complications and predictive factors for the successful treatment of flatback deformity (fixed sagittal imbalance). Spine (Phila Pa 1976). 24(16):1712-20, 1999
                                                          11. Lin RM et al: Lumbar lordosis: normal adults. J Formos Med Assoc. 91(3):329-33, 1992
                                                          12. La Grone MO: Loss of lumbar lordosis. A complication of spinal fusion for scoliosis. Orthop Clin North Am. 19(2):383-93, 1988