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KEY FACTS
Terminology
Imaging
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Abbreviations
- Flat back syndrome (FBS)
Synonyms
- Fixed sagittal imbalance (FSI), iatrogenic FBS/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
- Loss of lumbar lordosis (LL) after scoliosis or lower lumbar distraction instrumentation, vertebral fracture, ankylosing spondylitis, or degenerative disease
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
- Janjua MB et al: Surgical treatment of flat back syndrome with anterior hyperlordotic cages. Oper Neurosurg (Hagerstown). 18(3):261-70, 2020
- Chou D et al: The mini-open pedicle subtraction osteotomy for flat-back syndrome and kyphosis correction: operative technique. Oper Neurosurg (Hagerstown). 12(4):309-16, 2016
- Boissière L et al: Lumbo-pelvic related indexes: impact on adult spinal deformity surgery. Eur Spine J. 24(6):1212-8, 2014
- Vital JM et al: Osteotomies through a fusion mass in the lumbar spine. Eur Spine J. 1:S107-11, 2014
- 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
- Hedlund R: Pedicle subtraction osteotomy in flat back syndrome 38 years after Harrington instrumentation for AIS. Eur Spine J. 21(3):563-5, 2012
- Jagannathan J et al: Iatrogenic spinal deformity. Neurosurgery. 63(3 Suppl):104-16, 2008
- Potter BK et al: Prevention and management of iatrogenic flatback deformity. J Bone Joint Surg Am. 86-A(8):1793-808, 2004
- Wiggins GC et al: Management of iatrogenic flat-back syndrome. Neurosurg Focus. 15(3):E8, 2003
- Danisa OA et al: Surgical correction of lumbar kyphotic deformity: posterior reduction "eggshell" osteotomy. J Neurosurg. 92(1 Suppl):50-6, 2000
- 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
- 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
- Lin RM et al: Lumbar lordosis: normal adults. J Formos Med Assoc. 91(3):329-33, 1992
- La Grone MO: Loss of lumbar lordosis. A complication of spinal fusion for scoliosis. Orthop Clin North Am. 19(2):383-93, 1988
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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 FBS/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
- Loss of lumbar lordosis (LL) after scoliosis or lower lumbar distraction instrumentation, vertebral fracture, ankylosing spondylitis, or degenerative disease
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
- Janjua MB et al: Surgical treatment of flat back syndrome with anterior hyperlordotic cages. Oper Neurosurg (Hagerstown). 18(3):261-70, 2020
- Chou D et al: The mini-open pedicle subtraction osteotomy for flat-back syndrome and kyphosis correction: operative technique. Oper Neurosurg (Hagerstown). 12(4):309-16, 2016
- Boissière L et al: Lumbo-pelvic related indexes: impact on adult spinal deformity surgery. Eur Spine J. 24(6):1212-8, 2014
- Vital JM et al: Osteotomies through a fusion mass in the lumbar spine. Eur Spine J. 1:S107-11, 2014
- 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
- Hedlund R: Pedicle subtraction osteotomy in flat back syndrome 38 years after Harrington instrumentation for AIS. Eur Spine J. 21(3):563-5, 2012
- Jagannathan J et al: Iatrogenic spinal deformity. Neurosurgery. 63(3 Suppl):104-16, 2008
- Potter BK et al: Prevention and management of iatrogenic flatback deformity. J Bone Joint Surg Am. 86-A(8):1793-808, 2004
- Wiggins GC et al: Management of iatrogenic flat-back syndrome. Neurosurg Focus. 15(3):E8, 2003
- Danisa OA et al: Surgical correction of lumbar kyphotic deformity: posterior reduction "eggshell" osteotomy. J Neurosurg. 92(1 Suppl):50-6, 2000
- 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
- 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
- Lin RM et al: Lumbar lordosis: normal adults. J Formos Med Assoc. 91(3):329-33, 1992
- La Grone MO: Loss of lumbar lordosis. A complication of spinal fusion for scoliosis. Orthop Clin North Am. 19(2):383-93, 1988
