Flat back condition is a disorder of vertebral column in which the lower part of the vertebral column loses some part of its normal anatomical curve. In this condition, front to back imbalance in the vertebral column takes place which is also known as a sagittal imbalance.
Normally, the vertebral column has three curves. The lower (lumbar) region of the vertebral column has an inward curvature which is known as lordosis. The curvature of the thoracic region is directed outside which is known as kyphosis while the cervical region of the vertebral column also has lordosis. If the normal curvature of the lumbar region of the vertebral column is lost, the centre of gravity may be shifted top far forward. This actually happens in flat back syndrome.
Causes of Flat Back Syndrome
There may be many causes of a flat back syndrome some of which are discussed as follows.
- Degenerative Disc Disease. Progressive age-related degeneration of intervertebral discs which act as shock absorbers of the spinal column may result in decreased height in the frontal part of the vertebral column. When disc degeneration occurs, the vertebral column starts leaning forward and the lumbar curve decreases. The patient thus suffers from pain and stiffness because of degenerative disc disease or because of spinal imbalance.
- Lumbar Post Laminectomy. The patients who have been treated with a lumbar laminectomy or any other lumbar surgery to treat nerve compression or spinal stenosis, the lumbar flat back syndrome may take place. This procedure may result in a decrease of lumbar lordosis and in some cases, cause spinal column instability.
- Vertebral compression. Osteoporosis is an age-related bone degenerative process which leads to weakness of spinal bones and compression fractures. Because of any spinal fracture, the height of the spinal column in the lumbar and thoracic region is decreased. It can take place in one or more bones in the vertebral column and may lead to the flat back syndrome.
- Ankylosing Spondylitis. It is a chronic disease involving an inflammatory process in the joints of the body which also happens in the joints of the vertebral column which results in pain, swelling, and stiffness in the entire length of the vertebral column. In some patients of ankylosing spondylitis, a decrease in the lumbar region lordosis and an increase in the thoracic region kyphosis takes place, thus patient has an increased forward posture. It is common to happen lumbar flat back syndrome in such patients.
- After Scoliosis Treatment. This condition sometimes takes place after the correction of scoliosis. This is so because rods are used to correct the abnormal curvature in the patients of scoliosis. These rods also have a tendency to straighten the normal anatomical curvatures of the back.
Symptoms of Flat Back Syndrome
Obviously, the most common and first to be appreciated symptom of this disorder is the change in the shape of the back. Other symptoms may include
- The patient has the feelings of falling forward.
- Persistent pain in the muscles and joints of the back.
- Stooping often during the evening or night
Many persons with flat back syndrome require a walker or cane for help while walking because the posture of their body is such that they are leaned forward and their body weight is not centrally directed over their legs and pelvis. They might suffer from pain, frustration, and disability.
How should you sleep in this condition?
When you are suffering from a flat back disorder, you must provide better support to your body while sleeping. Put a soft pillow beneath your lumbar region and pelvis. You must either place a flat pillow or no pillow under your head to avoid straining of your back muscles. Sometimes, stomach sleeping may also be recommended.
The diagnosis of the flat back syndrome is made after taking the complete history and performing a good physical examination. Your doctor may also order relevant investigations to establish the correct diagnosis. The imaging studies which are commonly performed are X-Ray, CT scan, and MRI. An X-Ray is a long scan in an upright posture that clarifies the entire length of the vertebral column in a single image.
It is magnetic resonance imaging. This imaging technique uses radio waves and a magnet to give a detailed and clear image of the spinal column. Nerves can also be viewed clearly through an MRI scan. MRI scan is performed to view the bundles of nerve fibres and their condition either they are affected or not by the abnormal curve of the vertebral column.
The CT scan utilizes a computer and X-Rays to view the detailed image of the body. CT scan provides a more detailed image of the body than X-Ray.
The treatment at the initial stage of the flat back syndrome is only lifestyle modification, i.e. weight reduction and to include exercises in daily routine. Aerobic exercises are good for this purpose. They can be carried out along with weight-bearing exercises and muscle strengthening exercises. Spinal manipulation and physical therapy may also result in a good impact on the patient’s condition.
For some of the patients, endurance and conditioning programs may give good strength to muscles and thus symptoms are improved. Spinal injections for pain relief are given to the patients suffering from pinched nerves or arthritis.
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Some patients have severe structural problems and aggravating signs and symptoms so that medical treatment cannot provide enough relief. Thus, surgical intervention is needed in such circumstances. The aim of the surgical intervention in case of the flat back syndrome is to restore the spinal alignment and reduce pain. When the vertebral column becomes aligned, additional stress from the supporting muscles of legs, hips, and back is relieved and the patient feels comfortable.
The option of surgical intervention is selected for the patients for whom, non-surgical treatment is not beneficial. Surgery is also required for the patients whose condition is becoming worse with the passage of time or those who are suffering from nerve compression and have additional symptoms like weakness, pain in arms and legs, numbness and tingling sensations in the area of nerve supply. Surgery which is done for the correction of flat back deformity needs to be performed from combined or multiple approaches. The least invasive or safest procedure is chosen for the patient.