title: Management of iatrogenic flat-back syndrome.
abstract: 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.
authors.affiliation: Department of Neurological Surgery, David Grant Medical Center, Travis Air Force Base, California 94535-4800, USA. greg.wiggins@60mdg.travis.af.mil
authors.forename: Gregory C
authors.initials: GC
authors.lastname: Wiggins
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Ondra
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
mesh_terms: D001416:Back Pain / Q000209:etiology; D001696:Biomechanical Phenomena; D004867:Equipment Design; D006801:Humans; D007049:Iatrogenic Disease; D016268:Internal Fixators / Q000009:adverse effects*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control / Q000601:surgery*; D011187:Posture; D011542:Pseudarthrosis / Q000209:etiology; D011859:Radiography; D012086:Reoperation; D013121:Spinal Curvatures / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*