Flat back syndrome is a byproduct of fusion surgery—and one of the main reasons why most people try to avoid fusion if there are other options for treatment available. This article covers what flat back syndrome is and how it impacts fusion patients; it also describes how BalancedBack® technology can help you avoid flat back.

What is flat back syndrome?

Normal standing postureYour spine has natural, gentle curves that make it an “s” shape, from the cervical spine (the neck) to the thoracic spine (the base of the neck to the abdomen) to the lumbar spine (the lower back). (You’ll notice that a good portion of the curve is in the lumbar region.)

These curves work in harmony to keep your body balanced. As you move from sitting to standing to lying down, they adjust naturally to accommodate your various positions and to maintain your ideal posture, where your head is centered over your pelvis. When you’re standing upright, you have more of a curve in your spine than when you’re sitting. And when you’re sitting in a slumped position, you lose an even greater degree of curvature. These changes happen all day long, and are the reason you can move comfortably throughout the day.

When you undergo lumbar spinal fusion, one or more of the joints from your lower back are removed. In some cases, your lumbar region flattens out—a condition called flat back syndrome. That flattening can lead to a pitched-forward posture when standing.


Is fusion really the best option for treating your back pain? Download this free guide to read about all the surgical options available, and which one might be right for your specific condition.


What happens as a result of flat back syndrome?

Once your lumbar spine has lost its natural curvature, it becomes harder to stand. The low back muscles must work overtime to support posture. As a result, many fusion patients have a painful tendency to lean forward when standing. To compensate for carrying the center of mass too far forward you may even bend your hips and knees to find balance in what’s called “compensatory flexion.” As the biomechanics of your spine are altered, the levels of your spine adjacent to the fusion also begin to break down.

Surgeons sometimes try to avoid flat back syndrome by using high-tech fusion cages to add curvature to the spine (products known as expandable cages, hyperlordotic cages, etc.), but unfortunately, these procedures can be even more damaging than flat back syndrome. If you’re fused in a position more appropriate for standing, your spine then experiences tremendous stress when sitting and, particularly, slouching and slumped sitting. Most people sit a lot through the course of a day—at work, watching TV, or driving a car. This extreme stress while seated, caused by a fused curve in the spine that can’t naturally flatten out, will take a toll on your spine (and your mental health) over time. Ultimately, there’s simply no such thing as a “balanced” fusion posture.

What’s the alternative to fusion that avoids flat back syndrome?

For many patients, BalancedBack® is a better solution. The BalancedBack® procedure stabilizes and corrects your degenerated spine like a fusion, but without altering your natural sagittal spinal mechanics.

Rather than removing a joint as surgeons would during fusion, BalancedBack® surgeons implant a device that replaces the function of the worn-out joint completely, including the function of the disc and facet joints. Your joint replacement lets your spine keep moving naturally—you can flex and extend, adjusting your posture as needed throughout the day, in all positions. It’s the only implant that allows the spine to rebalance itself by recreating the normal curvature of your spine, keeping your head above your pelvis while standing, and allowing your spine to relax and flatten while sitting.

If you’d like to find out more about the BalancedBack® procedure—and whether you’re a good candidate for it—schedule a complimentary call with our clinical coordinator.

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