Spinal Problems Curvature Flatback

Flatback syndrome (also called “flatback deformity” or “fixed sagittal imbalance”) is characterized by the loss of the natural curves of the spine. People with flatback syndrome suffer from the effects of a straight spine, which can cause back pain, among other symptoms.

A straight spine is unable to flex and move the way a healthy spine can, and gives a person the appearance of being stooped forward. People with flatback syndrome often have difficulty standing up straight. The center of gravity is shifted, leading to an unsteady stance and gait.

Types of Flatback Syndrome

There are two types of flatback syndrome, characterized as “Type I” and “Type II.”

In people with Type I (or “compensated”) flatback syndrome, only part of the spine is affected. The unaffected parts of the spine above and below the fixed segments let the person compensate for fixed segments. The person may bend backward to control or maintain balance, which can cause premature wear and tear on the spinal discs.

Someone with Type II (or “decompensated”) flatback syndrome does not have sufficient healthy vertebral segments above or below the fixed segments to rebalance.

Symptoms of Flatback Syndrome

As a result of their straight spine, patients with flatback syndrome may experience:

  • A sensation of falling forward
  • Chronic groin, thigh, and back pain
  • Difficulty performing some daily activities
  • Fatigue.

If symptoms are severe, the patient may need a cane or walker, because the stooped-forward position prevents the body weight from being centered over pelvis and legs.

Causes and Prevention of Flatback Syndrome

The most common cause of flatback syndrome is lumbar spinal fusion surgery that heals into the flatback position.

The syndrome also sometimes occurs after surgery to correct scoliosis. The rods used to straighten the scoliosis curve tend to also straighten the normal curves of the back. This situation was more common before surgeons were able to correct scoliosis while keeping as much as possible of the normal spinal curvature.

Other possible causes of flatback syndrome include:

  • Arthritis of the spine
  • Osteoporosis of the spine
  • Severe degeneration of spinal discs.

Although you can’t prevent flatback syndrome if you require spinal fusion or scoliosis surgery, you can follow all of the normally recommended healthy steps to prevent osteoporosis and arthritis in order to prevent flatback syndrome.

Treatment of Flatback Syndrome

Treatment for the spinal problems of flatback syndrome depends on your age and health, the causes and extent of the condition, and your personal preferences. Options include:

  • A cane or walker for balance and to reduce pain
  • Anti-inflammatory medication to reduce pain
  • Braces
  • Physical therapy with a home exercise program tailored to your needs
  • Surgery

Various surgical options are also available to correct a fixed sagittal imbalance. One is to fuse the spine in a more balanced position. Removing some bone from the spine is another option, so that the spine can resume its normal curvature. Talk to your doctor for further advice.


Bridwell, K. (n.d.). Spinal curvature problems: Fixed sagittal imbalance. Retrieved March 12, 2010, from http://www.spineuniverse.com/conditions/kyphosis/spinal-


Cedars-Sinai Staff. (n.d.). Flatback syndrome. Retrieved March 12, 2010, from http://www.csmc.edu/5723.html

Oregon Health and Sciences University Staff. (n.d.). Ask the spine expert. Retrieved March 12, 2010, from http://www.ohsu.edu/health/page.cfm?id=13653

Stanford Hospital and Clinics Staff. (n.d.). Flat back/fixed sagittal imbalance. Retrieved March 12, 2010, from http://stanfordhospital.org/clinicsmedServices/COE/orthopaedics/spineCenter/patientEducation/flatBack.html