Flatback syndrome is a pathological condition characterized by a decrease in the severity of one or more physiological bends of the spine. When smoothing the thoracic bend, compression of the heart occurs, accompanied by pain, a decrease in load tolerance. With a decrease in the lumbar bend, the ability to maintain the vertical position of the body is impaired, patients are forced to bend the joints of the lower extremities while standing and walking. There are pains in the back and joints. Pathology is diagnosed according to examination, radiography, CT, MRI. Treatment is mainly surgical.
M43.8 Other specified deforming dorsopathies
Flatback (straight) syndrome is a condition in which the angle of thoracic kyphosis is less than 30 ° (taking into account age, fluctuations from 23 ° to 40 ° are possible), the angle of lumbar lordosis is less than 145 °. The congenital variant of pathology is detected in children and young people, characterized by a decrease in all bends, the presence of cardiological symptoms. With an acquired flatback, middle-aged and older patients usually suffer, lumbar flexion decreases, orthopedic disorders are detected.
Flatback syndrome causes
Straight back syndrome is a polyethological condition. Congenital flatback is a developmental anomaly. Acquired flattening of the bends of the vertebral column is most often formed after operations on the lumbar spine with fixation of the metal structure on the sacrum or lower lumbar vertebrae. Other possible causes of the development of a straight back include:
- increased kyphosis at the level of the thoracolumbar junction;
- fractures of the thoracolumbar vertebrae;
- lumbar spondylosis;
- instability of vertebrae with the development of spinal canal stenosis;
- bone block in the thoracolumbar junction;
- ankylosing spondylitis;
- contractures of the hip joints.
With congenital pathology, thoracic kyphosis is not pronounced, lumbar lordosis is smoothed, concomitant funnel-shaped breasts are often observed. Due to a significant decrease in the volume of the chest, the heart and large vessels are squeezed, resulting in clinical and auscultative symptoms that create a false picture of heart disease.
With the acquired type of pathology, the severity of lumbar lordosis decreases, the center of gravity shifts. To maintain balance in the standing position, patients are forced to bend their legs. Changing the position of the body leads to overstrain of the muscles, the appearance of pain in the back, joints of the lower extremities. With a long-term violation, contractures are formed.
Flatback syndrome symptoms
The smoothness of all the bends of the spine is noted. Cardiological symptoms usually occur during puberty, often increase with age. Patients complain of decreased endurance, pain in the heart, palpitations. Arrhythmias are possible. During auscultation, an ejection noise is heard, which can be mistakenly interpreted as a noise with an atrial septal defect or pulmonary artery stenosis.
Acquired straight back
Patients with a flatback complain of difficulty when staying in an upright position, instability when walking on uneven surfaces. Externally, the absence or significant reduction of lumbar lordosis is revealed. When standing, the body is tilted anteriorly, the cervical and thoracic sections are bent over, the pelvis is withdrawn posteriorly, the hip and knee joints are slightly bent.
When bending the back and attempting manual correction, the flattening of the lumbar region persists. Due to constant overexertion, fatigue is noted after minor physical activity, back pain often occurs. Pains are usually non-localized, aching or pulling, are detected mainly in the thoracolumbar and lumbar regions. They increase with prolonged standing, physical exertion.
Due to overextension of the upper spine, the pain syndrome spreads to the neck and upper back. With the long–term existence of a flatback or a primary articular lesion, flexor contractures of the hip joints, less often of the knee joints, can be determined.
A decrease in endurance in patients with a congenital type of pathology can cause disability. There are indications in the literature that mitral valve prolapse is often detected in such patients, but it is difficult to establish whether it is a consequence of a flatback or a parallel developing process. Some researchers mention the syndrome of compression cardiopotery, manifested by rhythm and conduction disorders. The non-physiological position of the body contributes to the development of degenerative changes in the spinal column.
Acquired flatback aggravates the course of the underlying disease of the spine or joints, leads to osteochondrosis, increases the likelihood of the formation of intervertebral hernias, spondyloarthrosis, arthrosis of the hip and knee joints, and other degenerative pathologies. Compression of spinal roots with the development of neurological symptoms is possible. With pronounced forms, there is a restriction or loss of working capacity.
Flat (straight) back syndrome is diagnosed by an orthopedic or neurosurgeon on the basis of objective examination data and the results of additional studies. To clarify the etiology of the syndrome, the anamnesis of life and disease is studied. The examination plan for the acquired variant of the disease includes the following diagnostic procedures:
- Spine x-ray. It is carried out in two projections with the capture of the entire spinal column in the vertical and horizontal position of the patient. The images show the smoothness of one or all of the physiological bends. With the acquired form, the deviation of the sagittal vertical axis is determined.
- CT of the spine. It is usually performed at the stage of preparation for surgery. Provides detailed visualization of all solid structures of the spinal column. Identifies false joints.
- MRI of the spine. It is indicated in the presence of neurological symptoms. Confirms compression of the roots, spinal canal stenosis.
In the presence of neurological disorders, a neurologist’s examination, electrophysiological studies are required. Patients with congenital flatback, along with radiography of the spine, are prescribed ECG and EchoCG to exclude cardiac diseases, assess the condition of the heart.
Flatback syndrome treatment
Treatment of congenital straight back
Treatment tactics are determined individually depending on the severity of symptoms, the presence of concomitant disorders. In case of minor manifestations, correction of the physical activity regime, observation by a cardiologist and an orthopedist is recommended. With concomitant funnel-shaped deformation, surgical intervention is performed. For the prevention of degenerative diseases of the spine, physical therapy, massage, physiotherapy are prescribed.
Treatment of acquired flatback
Conservative therapy as the main method of treatment is applicable only at the initial stages of the disease, in other cases it is used at the stage of preparation for surgery. The complex of measures is aimed at improving the mobility of joints and spine, increasing the tolerance of physical exertion. Can be used:
- Physical therapy. The complex includes exercises for the extension of the joints and spinal column, strengthening the muscles of the trunk and limbs. Supplemented with aerobic exercise.
- Immobilization of the spine. It is carried out using special bandages and orthopedic devices. Due to possible muscle hypotrophy, it is of a short-term nature.
- Blockades. With severe pain syndrome, epidural blockades with anesthetics are performed.
The tactics of surgical intervention are determined individually, taking into account the causes and severity of the deformity. The purpose of the operation may be to maintain sagittal balance with an increase in lumbar lordosis or to correct sagittal imbalance with the formation of hyperlordosis. Spondylotomy is performed with resection of the posterior structures and elongation of the anterior spine. It is possible to shorten the posterior and lateral structures without correcting the anterior sections.
The cardiological prognosis for congenital flat (straight) back is favorable, there is an increased likelihood of early development of degenerative pathologies of the spine. With an acquired disorder after surgery, in 95% of cases there is a significant reduction in pain syndrome and an improvement in posture. Significant residual pain persists in 35% of the operated patients.
Prevention of congenital pathology has not been developed. Measures aimed at preventing the formation of an acquired straight back include careful planning of operations on the spine, exclusion of fixation of metal structures to the lower vertebrae and sacrum, timely treatment of other diseases and injuries that can lead to the disappearance of lumbar lordosis.