Flatback deformity is a condition of the spine in which the normal inward curve of the lower back (lumbar lordosis) is reduced. Patients with flatback deformity lean forward and have difficulty standing upright. This causes significant pain and fatigue in the back and legs.
Causes of Flatback Deformity
• Prior spine surgery (particularly fusion surgery that did not maintain normal lumbar lordosis) • Adjacent segment degeneration after previous fusion • Degenerative disc disease causing progressive loss of lumbar lordosis • Adult degenerative scoliosis with associated flatback • Ankylosing spondylitis
Symptoms
• Inability to stand upright without bending the knees or leaning forward • Chronic low back and hip pain • Fatigue — difficulty maintaining upright posture • Progressive worsening of symptoms over time • Leg pain from associated stenosis
Treatment
Non-Surgical: Physiotherapy, core strengthening, and pain management can provide temporary relief but do not correct the underlying deformity. Surgical Treatment: Osteotomy procedures to restore lumbar lordosis: • Pedicle subtraction osteotomy (PSO): A complex surgery that removes a wedge of bone from a single vertebra to restore lordosis • Smith-Petersen osteotomy: Less invasive but provides less correction • Combined anterior-posterior approaches using ALIF/OLIF Dr. Kardile specializes in these complex reconstructive procedures.