Penn Orthopaedics

Flat Back Syndrome

Flat back syndrome occurs when there is a loss of either lordosis, the inward curve of the spine near the pelvis, or kyphosis, the outward curve of the spine near the chest, or both, making the spine straight.

Flat back syndrome can occur after scoliosis, curvature of the spine, has been surgically corrected. It can also result from spinal arthritis, degenerative disk disease, vertebral compression fracture or spinal fusion surgery. It is often diagnosed in older adults who have had scoliosis surgery, but can be found in patients of any age.


Patients with flat back syndrome appear stooped forward. Other symptoms include:

  • Difficulty standing up straight
  • A feeling of falling forward
  • Stooping by the end of the day
  • Chronic back muscle pain
  • Fatigue

Tests for flat back syndrome may include standing spinal X-rays.


Initially, patients with flat back syndrome may be treated with physical therapy and non-steroidal, anti-inflammatory medication. If these treatments are unsuccessful, reconstructive spinal surgery may be considered.

For patients who previously had instrumentation placed in the spine to correct scoliosis, the procedure may be as simple as removing the instrumentation. For others, the surgery may involve spinal readjustment and/or the placement of new instrumentation. Surgical patients are kept on bed rest for 48 hours. Recovery from this type of surgery usually takes at least six months.

All surgery carries some risk of complications. Surgery for flat back syndrome may result in neurologic injury, tears to the dura or outermost layer of the membrane surrounding the spine or incomplete relief of symptoms.