title: A critical appraisal of the pain associated with iatrogenic adult spinal deformity, and treatment by spinal cord stimulation. A case report and review of the literature.
abstract: Objective. Over the past two decades, with the increasing use of spinal instrumentation to treat deformity, surgical restoration has become more frequent. A complication of surgical reconstruction for adult scoliosis, the iatrogenic flat back syndrome, has been described. Results of surgical realignment have been disappointing in terms of pain relief. The objective of this study is to examine a case of so-called flat back deformity and describe treatment via spinal cord stimulation. Materials and Methods. This is a case report of an individual who presented a spine center with the flat back deformity and pain. Results. Following exclusion of reversible compressive pathology, a 46 year-old male with the iatrogenic flat back deformity and lumbosacral and thigh pain was treated with implantation of a thoracic spinal cord stimulator. Significant pain relief was obtained without resorting to additional major reconstructive surgery. Conclusions. Literature on the pain associated with flat back deformity is incomplete regarding description and characterization of pain. Given the unpredictability of spinal osteotomy to address this pain, a possible alternative treatment strategy is presented. This involves the use of selective pharmaceutical therapy and spinal cord stimulation. Based on the response of this patient to spinal cord stimulation, it is a possible that a component of this persistent pain is neuropathic, despite the fact that preoperative imaging studies failed to disclose a significant compressive lesion.
authors.affiliation: Section of Orthopaedic Surgery and Rehabilitation, The University of Chicago Spine Center, and                    Section of Anethesia and Critical Care, Pain Management Center, The University of Chicago Hospitals, Louis A. Weiss Memorial Hospital, Chicago, Illinois.
authors.forename: F T
authors.initials: FT
authors.lastname: Wetzel
authors.forename: L P
authors.initials: LP
authors.lastname: Tansey
authors.forename: F M
authors.initials: FM
authors.lastname: Phillips
authors.forename: D M
authors.initials: DM
authors.lastname: Sinclair