Straighten spine (Flatback syndrome)
The flatback syndrome is an abnormal condition where the spine loses its natural low back curve to become flat. It is a type of sagittal imbalance or front to back imbalance in the spine.
Normally the spine has several gentle fronts to back curves. The Lumbar (Lower) spine has a lordosis or inward curve. The thoracic (Middle) spine has kyphosis or outward curve, and the cervical spine (neck) has a lordosis. These curves usually work in harmony to keep the body's center of gravity aligned over the hips and pelvis. If the lumbar lordosis is lost the center of gravity can be put too far forward. This is the case in flatback syndrome.
The human spine has natural curvatures. When you look at a back from behind, the spine should be straight and centered over the pelvis. However, when you look at the spine from the side, the curves are designed to maintain balance as the spine is behind organs in the chest and abdomen. The spine has two alternating curves to create an "S" like shape.
In the neck and low back, there is normally an inward curvature or sway back known as lordosis. I the thoracic spine and sacrum there is an outward curvature known as Kyphosis or hunchback. These curves normally balance out each other so that when the patient stands they are well balanced with their head straight above their hips when viewed from the side. Standing in this position minimizes the effect of gravity and allows the patient to stand with the best posture and use the least energy when moving or walking.
The flatback syndrome is an abnormal condition where the spine loses its natural low back curve to become flat. The spine becomes imbalanced and the patient leans forward. Patients with flat back syndrome typically notice troubles standing upright or have ongoing back or leg pain. Symptoms usually worsen as the day goes on and the patient feels they lean further and further forward the longer they tey to stand upright. The severity of the symptoms usually depends on the amount of curvature present and difficulties with standing erect.
In patients with the flat back syndrome, a loss of normal lumbar curvature causes an imbalance of the spine. The patient's head begins to lean forward, away from the body and they may have trouble standing upright. This imbalance can cause muscle fatigue and pain.
The flatback syndrome was first noted in patients who received a specific type of spinal instrumentation for scoliosis treatment. Early types of scoliosis implants, called Harrington rods, allowed the surgeon to straighten the back curvature but also decreased the spine's normal side curvature.
Causes:
Term flat back syndrome has been broadened to include any patient with a decrease in lumbar lordosis causing symptoms. As such, flat back syndrome can occur as a result of any condition that shortens the front portion of the spine, causing the patient to lean forward.
The flatback syndrome may develop as the result of the following causes: Degenerative Disc Disease, Lumbar post Laminectomy syndrome, compression fractures, Ankylosing spondylitis.
Degenerative Disc Disease:
The progressive degeneration of the intervertebral disc or the shock absorbers of the spine may lead to a loss of height in the front part of the spine. As discs degenerate the spine begins to lean forward and lumbar lordosis decreases. The patient may develop pain as a result of the degenerative disc disease or a result of the spinal imbalance.
Lumbar post Laminectomy syndrome:
The lumbar flat back syndrome may develop in patients previously treated with a laminectomy or other lumbar surgery to decompress the spinal nerves to treat stenosis. These procedures can lead to a decrease in lumbar lordosis and in some cases spinal instability.
Vertebral compression fractures:
Compression fractures are often the result of weak spinal bones due to Osteoporosis. A fracture can lead to loss of height of the bone in the thoracic and lumbar spine. This may occur in one bone or in multiple bones throughout the spine, resulting in flatback syndrome.
Ankylosing spondylitis:
Ankylosing spondylitis is a chronic inflammatory disease that causes stiffness and arthritis throughout the entire spine. Some patients with AS notice an increasing forward posture of the spine, including an increase in thoracic kyphosis or a decrease in lumbar lordosis.
Symptoms:
The flatback syndrome can cause difficulty standing upright, chronic pain, and difficulty with daily tasks. In order to stand upright, a person with flatback syndrome must contract the back muscles, and possibly flex at the hips and knees. These maneuvers may temporarily help a person stand upright, but over time, they may result in severe pain.
Diagnosis:
To determine the degree of the flatback syndrome, the doctor may order an X-ray test that produces images of the spine and other bones and tissues using invisible electromagnetic rays. This may be a long cassette upright scan that shows the entire spine in a single image. The doctor may also order additional diagnostic procedures to obtain a more detailed image of the spine:
- Magnetic resonance (MR) imaging scan- uses a magnet and radio waves to provide detailed images of the spinal cord, can help identify whether the spinal cord (the bundle of nerves connecting brain and body) has been affected by the spinal curvature.
- Computed tomography (CT) scan- uses x-rays and a computer to produce detailed images of the body. CT scans are more detailed than general X-rays.
The flatback syndrome is an abnormal condition where the spine loses its natural low back curve to become flat. It is a type of sagittal imbalance or front to back imbalance in the spine.
Normally the spine has several gentle fronts to back curves. The Lumbar (Lower) spine has a lordosis or inward curve. The thoracic (Middle) spine has kyphosis or outward curve, and the cervical spine (neck) has a lordosis. These curves usually work in harmony to keep the body's center of gravity aligned over the hips and pelvis. If the lumbar lordosis is lost the center of gravity can be put too far forward. This is the case in flatback syndrome.
The human spine has natural curvatures. When you look at a back from behind, the spine should be straight and centered over the pelvis. However, when you look at the spine from the side, the curves are designed to maintain balance as the spine is behind organs in the chest and abdomen. The spine has two alternating curves to create an "S" like shape.
In the neck and low back, there is normally an inward curvature or sway back known as lordosis. I the thoracic spine and sacrum there is an outward curvature known as Kyphosis or hunchback. These curves normally balance out each other so that when the patient stands they are well balanced with their head straight above their hips when viewed from the side. Standing in this position minimizes the effect of gravity and allows the patient to stand with the best posture and use the least energy when moving or walking.
The flatback syndrome is an abnormal condition where the spine loses its natural low back curve to become flat. The spine becomes imbalanced and the patient leans forward. Patients with flat back syndrome typically notice troubles standing upright or have ongoing back or leg pain. Symptoms usually worsen as the day goes on and the patient feels they lean further and further forward the longer they tey to stand upright. The severity of the symptoms usually depends on the amount of curvature present and difficulties with standing erect.
In patients with the flat back syndrome, a loss of normal lumbar curvature causes an imbalance of the spine. The patient's head begins to lean forward, away from the body and they may have trouble standing upright. This imbalance can cause muscle fatigue and pain.
The flatback syndrome was first noted in patients who received a specific type of spinal instrumentation for scoliosis treatment. Early types of scoliosis implants, called Harrington rods, allowed the surgeon to straighten the back curvature but also decreased the spine's normal side curvature.
Causes:
Term flat back syndrome has been broadened to include any patient with a decrease in lumbar lordosis causing symptoms. As such, flat back syndrome can occur as a result of any condition that shortens the front portion of the spine, causing the patient to lean forward.
The flatback syndrome may develop as the result of the following causes: Degenerative Disc Disease, Lumbar post Laminectomy syndrome, compression fractures, Ankylosing spondylitis.
Degenerative Disc Disease:
The progressive degeneration of the intervertebral disc or the shock absorbers of the spine may lead to a loss of height in the front part of the spine. As discs degenerate the spine begins to lean forward and lumbar lordosis decreases. The patient may develop pain as a result of the degenerative disc disease or a result of the spinal imbalance.
Lumbar post Laminectomy syndrome:
The lumbar flat back syndrome may develop in patients previously treated with a laminectomy or other lumbar surgery to decompress the spinal nerves to treat stenosis. These procedures can lead to a decrease in lumbar lordosis and in some cases spinal instability.
Vertebral compression fractures:
Compression fractures are often the result of weak spinal bones due to Osteoporosis. A fracture can lead to loss of height of the bone in the thoracic and lumbar spine. This may occur in one bone or in multiple bones throughout the spine, resulting in flatback syndrome.
Ankylosing spondylitis:
Ankylosing spondylitis is a chronic inflammatory disease that causes stiffness and arthritis throughout the entire spine. Some patients with AS notice an increasing forward posture of the spine, including an increase in thoracic kyphosis or a decrease in lumbar lordosis.
Symptoms:
The flatback syndrome can cause difficulty standing upright, chronic pain, and difficulty with daily tasks. In order to stand upright, a person with flatback syndrome must contract the back muscles, and possibly flex at the hips and knees. These maneuvers may temporarily help a person stand upright, but over time, they may result in severe pain.
Diagnosis:
To determine the degree of the flatback syndrome, the doctor may order an X-ray test that produces images of the spine and other bones and tissues using invisible electromagnetic rays. This may be a long cassette upright scan that shows the entire spine in a single image. The doctor may also order additional diagnostic procedures to obtain a more detailed image of the spine:
- Magnetic resonance (MR) imaging scan- uses a magnet and radio waves to provide detailed images of the spinal cord, can help identify whether the spinal cord (the bundle of nerves connecting brain and body) has been affected by the spinal curvature.
- Computed tomography (CT) scan- uses x-rays and a computer to produce detailed images of the body. CT scans are more detailed than general X-rays.
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