Iatrogenic Flatback and Flatback Syndrome Evaluation, Management, and Prevention

被引:24
作者
Boody, Barrett S. [1 ]
Rosenthal, Brett D. [1 ]
Jenkins, Tyler J. [1 ]
Patel, Alpesh A. [1 ]
Savage, Jason W. [2 ]
Hsu, Wellington K. [1 ]
机构
[1] Northwestern Mem Hosp, Dept Orthopaed Surg, Chicago, IL 60611 USA
[2] Cleveland Clin Ctr Spine Hlth, Cleveland, OH USA
来源
CLINICAL SPINE SURGERY | 2017年 / 30卷 / 04期
关键词
iatrogenic flatback; flatback deformity; flatback syndrome; sagittal imbalance; ADULT-SPINAL-DEFORMITY; PROXIMAL JUNCTIONAL KYPHOSIS; LUMBAR INTERBODY FUSION; PEDICLE SUBTRACTION OSTEOTOMY; HARRINGTON INSTRUMENTATION; SAGITTAL ALIGNMENT; IDIOPATHIC SCOLIOSIS; PREDICTIVE FACTORS; SURGICAL-TREATMENT; CLINICAL-OUTCOMES;
D O I
10.1097/BSD.0000000000000522
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Flatback syndrome can be a significant source of disability, affecting stance and gait, and resulting in significant pain. Although the historical instrumentation options for thoracolumbar fusion procedures have been commonly regarded as the etiology of iatrogenic flatback, inappropriate selection, or application of modern instrumentation can similarly produce flatback deformities. Patients initially compensate with increased lordosis at adjacent lumbar segments and reduction of thoracic kyphosis. As paraspinal musculature fatigues and discs degenerate, maintaining sagittal balance requires increasing pelvic retroversion and hip extension. Ultimately, disc degeneration at adjacent levels overcomes compensatory mechanisms, resulting in sagittal imbalance and worsening symptoms. Nonoperative management for sagittally imbalanced (sagittal vertical axis > 5 cm) flatback syndrome is frequently unsuccessful. Despite significant complication rates, surgical management to recreate lumbar lordosis using interbody fusions and/or osteotomies can significantly improve quality of life.
引用
收藏
页码:142 / 149
页数:8
相关论文
共 47 条
[1]   THE EFFECT OF HARRINGTON INSTRUMENTATION ON THE SAGITTAL CONFIGURATION AND MOBILITY OF THE SPINE IN SCOLIOSIS [J].
AARO, S ;
OHLEN, G .
SPINE, 1983, 8 (06) :570-575
[2]  
[Anonymous], 2013, SPINE PHILA PA 1976, DOI DOI 10.1097/BRS.0B013E318292B7B9
[3]   Major Complications and Comparison Between 3-Column Osteotomy Techniques in 105 Consecutive Spinal Deformity Procedures [J].
Auerbach, Joshua D. ;
Lenke, Lawrence G. ;
Bridwell, Keith H. ;
Sehn, Jennifer K. ;
Milby, Andrew H. ;
Bumpass, David ;
Crawford, Charles H. ;
O'Shaughnessy, Brian A. ;
Buchowski, Jacob M. ;
Chang, Michael S. ;
Zebala, Lukas P. ;
Sides, Brenda A. .
SPINE, 2012, 37 (14) :1198-1210
[4]   Safety and efficacy of osteotomies in adult spinal deformity: what happens in the first year? [J].
Ayhan, Selim ;
Aykac, Bilal ;
Yuksel, Selcen ;
Guler, Umit Ozgur ;
Pellise, Ferran ;
Alanay, Ahmet ;
Sanchez Perez-Grueso, Francisco Javier ;
Acaroglu, Emre .
EUROPEAN SPINE JOURNAL, 2016, 25 (08) :2471-2479
[5]   SEGMENTAL ANALYSIS OF THE SAGITTAL PLANE ALIGNMENT OF THE NORMAL THORACIC AND LUMBAR SPINES AND THORACOLUMBAR JUNCTION [J].
BERNHARDT, M ;
BRIDWELL, KH .
SPINE, 1989, 14 (07) :717-721
[6]   Complications and intercenter variability of three-column osteotomies for spinal deformity surgery: a retrospective review of 423 patients [J].
Bianco, Kristina ;
Norton, Robert ;
Schwab, Frank ;
Smith, Justin S. ;
Klineberg, Eric ;
Obeid, Ibrahim ;
Mundis, Gregory, Jr. ;
Shaffrey, Christopher I. ;
Kebaish, Khaled ;
Hostin, Richard ;
Hart, Robert ;
Gupta, Munish C. ;
Burton, Douglas ;
Ames, Christopher ;
Boachie-Adjei, Oheneba ;
Protopsaltis, Themistocles S. ;
Lafage, Virginie .
NEUROSURGICAL FOCUS, 2014, 36 (05)
[7]   Reciprocal sagittal alignment changes after posterior fusion in the setting of adolescent idiopathic scoliosis [J].
Blondel, B. ;
Lafage, V. ;
Schwab, F. ;
Farcy, J. P. ;
Bollini, G. ;
Jouve, J. L. .
EUROPEAN SPINE JOURNAL, 2012, 21 (10) :1964-1971
[8]   Complications and predictive factors for the successful treatment of flatback deformity (fixed sagittal imbalance) [J].
Booth, KC ;
Bridwell, KH ;
Lenke, LG ;
Baldus, CR ;
Blanke, KM .
SPINE, 1999, 24 (16) :1712-1720
[9]   Decision making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity [J].
Bridwell, Keith H. .
SPINE, 2006, 31 (19) :S171-S178
[10]   Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance [J].
Bridwell, KH ;
Lewis, SJ ;
Lenke, LG ;
Baldus, C ;
Blanke, K .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 2003, 85A (03) :454-463