Scoliosis Surgery: Flatback Syndrome and Surgery
Flatback Syndrome Surgery
Flatback is a condition that develops in some patients treated with
Harrington rod instrumentation or other instrumentation or from other conditions
such as osteoarthritis or ankylosing spondylitis. In some patients with Harrington
rods, the rods extend into the lower part of the lumbar spine (L4, L5). Harrington
rods were the first type of spinal instrumentation used to treat scoliosis developed
in the 1960s by Dr. Paul Harrington. The Harrington rod was a great advancement
at the time and allowed for better scoliosis correction and higher spinal fusion
rates. Previous to the Harrington rod, patients were put into body casts and
assigned bed rest for as long as one-year.
Flatback develops from a straightening of the normal lordosis (inward sway) in the lumbar spine. At first, the unfused spinal segments compensate for the straightening effects, but eventually the discs degenerate and wear down. The patient develops back pain, difficulty standing upright, and experiences limitations when walking. Eventually, the problem requires a spinal realignment procedure with an osteotomy such as a pedicle subtraction osteotomy.
Flatback Syndrome (below): Please note the gravity line falls far forward in the flatback patient making it difficult to stand upright.
 Normal |
 Flatback |
Flatback Syndrome (below): 61-year-old female 30-years after Harrington rod implantation with flatback. Please note the gravity line arrows before and after surgery. The patient is hunched forward prior to surgery and restored to normal posture after surgery.
 Before |
After |
