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Mount Sinai Spine Center
5 East 98th Street, 4th floor
New York, NY 10029

Mount Sinai Doctors Manhasset
1155 Northern Boulevard,
3rd Floor, Suite 300
Manhasset, NY 11030

Flatback Syndrome

Flatback syndrome is a group of disorders characterized by the individual having difficulty standing upright due to a loss of lordosis or sway in the lower back causing the patient to be pitched forward. This is commonly associated with the old Harrington rod procedure performed decades ago for scoliosis. In those years, patients often had spinal fusions extending into the lower lumbar area. The corrective maneuver performed with the Harrington rod caused flattening or straightening of the normal lumbar lordosis. For a period of time, often spanning decades following surgery, patients are able to compensate with the normal discs below the fusion which hyperextend. Eventually, those discs degenerate and prevent the patient from standing upright, comfortably. Patients complain of back pain and have significant disability. Other causes of flatback syndrome include degenerative (wear and tear) disc disease involving multiple levels of the spine, ankylosing spondylitis a type of arthritis involving the spine, and post laminectomy kyphosis or loss of lordosis (sway) due to a laminectomy (removal of bone) performed for spinal stenosis.

Although attempts can be made at nonoperative treatment, typically, flatback syndrome is treated with surgery. This entails instrumentation of the spine combined with osteotomies (cutting through the spinal column) to realign the spine and provide the patient with comfortable alignment and balance. These ostetomies are complex, involving a removal of a wedge of bone around the spinal cord or nerve roots known as a kyphectomy or pedicle subtraction osteotomy. This type of surgery requires the expertise of a highly skilled surgeon such as Dr. Lonner. Restoration of function and quality of life is often quite remarkable following surgery for flatback syndrome.

Patient Story 1

This middle-aged lady had suffered from flatback syndrome with severe pain after undergoing corrective scoliosis surgery by another surgeon, with poor alignment established in the lateral (side) plane. In addition, one of the screws from the prior surgery was broken. She had great difficulty walking and had to use a rolling walker. Her pain was so severe prior to surgery that she could hardly stand and was taking strong narcotic medications. After having surgery with Dr. Lonner, she regained her balance and was able to walk unassisted, returned to full activities and she no longer requires pain medication.


Patient Story 2

Cathy is a 43-year-old lady who developed flatback syndrome as the result of Harrington rod instrumentation in her teens. She had suffered from severe progressive back pain with great difficulties in standing and walking. After surgery, Cathy’s pain improved dramatically and she returned to a life full of activities.