Spinal deformities · Long Beach, CA
Flatback in Long Beach, CA
Flatback syndrome is the loss of the normal inward curve of the lower back. The spine tips forward, and the body has to work constantly just to stay upright.
Flatback care in Long Beach, with patients welcome from across South Bay, Orange County and the greater Los Angeles area.
Overview
What is flatback syndrome?
A healthy lower back curves inward (lordosis), which keeps the head balanced over the pelvis with very little effort. In flatback syndrome that curve is lost. The upper body leans forward, and to compensate you bend your knees, tilt your pelvis and strain your back and hip muscles to stay upright. It works for a while, but the effort builds through the day and becomes exhausting and painful.
Flatback most often follows spinal surgery, especially older fusions that were fixed in a flat position, but it also develops from degenerative disc disease, compression fractures and ankylosing spondylitis. It is a problem of overall spinal balance rather than one bad level, which is why it needs a surgeon who looks at the whole picture. Dr. Bhalla sees flatback frequently in patients seeking a second opinion after previous surgery.
Causes
What causes it
Anything that removes the lower back curve or stiffens the spine in a flat position can lead to flatback.
Previous fusion surgery
The most common cause. A fusion that healed flat, or one done with older rod systems, locks the spine without its curve.
Wear above or below a fusion
Levels next to a fusion take on extra load and collapse forward over time (adjacent segment disease).
Degenerative disc disease
Multiple discs losing height at the front gradually flattens the lumbar curve.
Compression fractures
Osteoporotic fractures wedge the vertebrae forward and reduce the curve.
Ankylosing spondylitis
Inflammatory arthritis that can fuse the spine in a stooped position.
Hip and pelvic factors
Stiff hips and a pelvis that cannot rotate backward leave the spine without its usual compensation.
Symptoms
What it feels like
The hallmark of flatback is a day that starts fine and gets harder. Standing upright becomes an effort you can feel.
Common symptoms
- Difficulty standing up straight, especially later in the day
- A sense of pitching forward when walking
- Needing to bend the knees or lean on a cart to stay upright
- Low back pain and fatigue that build with standing or walking
- Pain in the hips, thighs and neck from compensating
- Trouble looking straight ahead without extending the neck
See a doctor right away if
- New leg weakness, numbness or difficulty walking
- Loss of bladder or bowel control
- Sudden severe back pain after a fall or minor injury
- Rapid worsening of your ability to stand upright
These can be signs of a problem that needs urgent care. Call (562) 427-8119 or go to the nearest emergency room.
Diagnosis
How we assess it
Flatback is diagnosed by measuring your whole body alignment, not just one part of the spine.
01/Listen
History and previous surgery
Earlier operations, how your standing tolerance has changed and what helps you stay upright.
02/Examine
Standing examination
Your natural stance, knee bend, pelvic tilt, hip motion and a neurological check, observed as you stand and walk.
03/Image
Full length standing X rays
Head to pelvis films measure how far your trunk sits forward of your hips and the curve missing from your lower back. CT and MRI show the fusion, discs and nerves.
04/Plan
Balance the whole spine
Dr. Bhalla explains how much correction you need, where it should come from and whether surgery is the right step.
Treatment
How it is treated
Mild flatback can be managed with therapy and hip and core strength. When the loss of balance is structural and disabling, surgery to restore the curve is one of the most life changing procedures in spine care.
First: without surgery
Where almost everyone starts
- Physical therapy focused on hip flexor stretching and extensor strength
- Core and gluteal strengthening to improve standing endurance
- Treatment of stiff hips, which can restore some compensation
- Pain management, pacing and walking aids as needed
- Osteoporosis treatment to protect against further collapse
When needed: surgery
The least invasive option that will work
- Osteotomy to restore the lumbar curve, often through or next to a previous fusion
- Extending or revising a prior fusion to achieve balanced alignment
- Interbody cages from the front or side to rebuild disc height and lordosis
- Navigation and intraoperative imaging to confirm correction before closing
Everyday care
Managing flatback day to day
While a plan is made, and after any treatment, these habits reduce the daily effort of staying upright.
- 01Stretch your hip flexors every day. Tight hips pull the pelvis and trunk forward.
- 02Strengthen glutes and back extensors so standing takes less effort.
- 03Break up long periods of standing and walking with short rests.
- 04Use a walking pole or cart for longer outings rather than pushing through.
- 05Avoid soft chairs you sink into. A firm seat with lumbar support helps.
- 06Keep a record of your standing tolerance. It helps track whether things are changing.
Questions
Things patients ask about flatback.
If your question is not here, call the office. We are happy to talk it through.
Why did this happen after my fusion?
Older fusion techniques often fixed the spine in a flat position, and even well done fusions can be followed by wear at the levels next to them. Over years the spine loses its curve and the body runs out of ways to compensate. It is not something you did wrong.
Can exercise fix flatback?
Exercise can improve standing endurance and reduce pain when the loss of curve is mild and your hips and remaining spine can still compensate. It cannot restore a curve that has been lost structurally, but it is still important before and after any surgery.
What does flatback surgery involve?
The spine is realigned by removing a wedge of bone or rebuilding disc spaces to recreate the lower back curve, then stabilized with screws and rods. It is a major operation, planned carefully from your standing X rays, and performed by Dr. Bhalla with navigation to confirm the correction.
Is it worth having another operation?
For patients who cannot stand upright or walk comfortably despite good non surgical care, restoring alignment often returns the ability to stand, walk and look ahead without constant effort. Dr. Bhalla will give you an honest view of the likely benefit and the risks in your specific case.
Near you
Flatback treatment in Long Beach, CA
If you are living with flatback in Long Beach or a nearby city, Dr. Bhalla can examine you, explain your options and plan the least invasive treatment that will work. Dr. Bhalla leads the Spine Center at MemorialCare Long Beach Medical Center.
Most people start with a consultation and imaging. Patients come from Signal Hill, Lakewood, Seal Beach, Orange County and across Southern California.
Patients come to us from
- Long Beach
- Signal Hill
- Lakewood
- Seal Beach
- Los Alamitos
- Cypress
- Bellflower
- Torrance
- Huntington Beach
- Carson
Not on the list? We see patients from across Southern California.
Related services
How we treat it.
Non-Surgical Care
Evaluation, physical therapy, medication and targeted treatment first. Surgery only when it is truly the answer.
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Revision Spinal Surgery
Expert care when a previous spine surgery has not delivered the result you hoped for.
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Minimally Invasive Spinal Surgery
Small incisions, muscle-sparing tools and faster recovery for the neck and back.
Learn more