Management of iatrogenic flat-back syndrome

Gregory C. WigginsDepartment of Neurological Surgery, David Grant Medical Center, Travis Air Force Base, California; Department of Neurological Surgery, Northwestern University Medical School, Chicago, Illinois; and Department of Neurological Surgery, University of Washington, Seattle, Washington

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Stephen L. OndraDepartment of Neurological Surgery, David Grant Medical Center, Travis Air Force Base, California; Department of Neurological Surgery, Northwestern University Medical School, Chicago, Illinois; and Department of Neurological Surgery, University of Washington, Seattle, Washington

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Christopher I. ShaffreyDepartment of Neurological Surgery, David Grant Medical Center, Travis Air Force Base, California; Department of Neurological Surgery, Northwestern University Medical School, Chicago, Illinois; and Department of Neurological Surgery, University of Washington, Seattle, Washington

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Iatrogenic loss of lordosis is now frequently recognized as a complication following placement of thoracolumbar instrumentation, especially with distraction instrumentation. Flat-back syndrome is characterized by forward inclination of the trunk, inability to stand upright, and back pain. Evaluation of the deformity should include a full-length lateral radiograph obtained with the patient's knees and hips fully extended. The most common cause of the deformity includes the use of distraction instrumentation in the lumbar spine and pseudarthrosis.

Surgical treatment described in the literature includes opening (Smith-Petersen) osteotomy, polysegmental osteotomy, and closing wedge osteotomy. The authors will review the literature, cause, clinical presentation, prevention, and surgical management of flat-back syndrome.

Abbreviations used in this paper:

VB = vertebral body.

Iatrogenic loss of lordosis is now frequently recognized as a complication following placement of thoracolumbar instrumentation, especially with distraction instrumentation. Flat-back syndrome is characterized by forward inclination of the trunk, inability to stand upright, and back pain. Evaluation of the deformity should include a full-length lateral radiograph obtained with the patient's knees and hips fully extended. The most common cause of the deformity includes the use of distraction instrumentation in the lumbar spine and pseudarthrosis.

Surgical treatment described in the literature includes opening (Smith-Petersen) osteotomy, polysegmental osteotomy, and closing wedge osteotomy. The authors will review the literature, cause, clinical presentation, prevention, and surgical management of flat-back syndrome.

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