Describe the surgical treatment for flatback syndrome

Fixed sagittal plane imbalance, or flatback syndrome, refers to symptomatic loss of sagittal plane balance primarily through straightening of the normal lumbar lordosis. Symptoms include pain and inability to stand upright with the head centered over the sacrum without bending the knees. Patients typically report a sense of leaning forward, thoracic pain, neck pain, and leg fatigue. Surgical treatment options include osteotomies (Smith-Petersen type or pedicle subtraction type), combined anterior and posterior procedures, or vertebral column resection procedures.

Key Points

1. Selection of appropriate candidates for revision spinal surgery depends on comprehensive assessment to determine the factors that led to a less than optimal outcome following initial surgery.

2. For poor surgical outcomes due to errors in surgical strategy or surgical technique associated with the index procedure, appropriate revision surgery may offer a reasonable chance of improved outcome.

3. For surgical failures due to errors in diagnosis or inappropriate patient selection for initial surgery, revision surgery offers little chance for improved outcome.

4. In the absence of relevant and specific anatomic and pathologic findings, pain itself is not an indication for revision surgery.


Complications of revision spinal surgery: Revision anterior lumbar surgery: Proximal fusion levels: Sagittal imbalance: Revision surgery for spinal deformity:


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