Part of understanding the structure and function of the spine means understanding why it’s curved in the first place. The spine is complex with many different parts that all play a role in its biomechanics. ‘Lordosis’ refers to the natural C-shaped curvature of the spine, and when there is a loss of lumbar lordosis, a syndrome known as ‘flatback’ can develop.
‘Lumbar’ refers to the lower-back section of the spine, and ‘lordosis’ refers to the spine’s C-shaped sideways curvatures. When there is a loss of lumbar lordosis, the lower spine’s natural inward curvature has become straighter, making that section of the spine flatter than it should be. Keep reading to find out what causes a loss of lumbar lordosis.
In order to better understand what’s involved in a loss of lumbar lordosis, as well as the condition that can develop as a result, let’s first explore some basic spinal anatomy and terminology; then we can have a more detailed look at lumbar lordosis and flatback syndrome.
Table of Contents
With all the focus on the many spinal conditions that can develop and how they affect the parts and structure of the spine, it’s important to remember just how important the spine’s natural curvatures are.
When you look at the spine from different angles, you can see the curvatures that characterize different sections of the spine.
If you were to look at an individual straight on, in the frontal plane, a healthy spine would look straight. If you were to look at that same person from the side view (also known as the sagittal plane), you would see a series of curves to the spine giving it a soft ‘S’ shape.
The spine has three main sections: cervical (neck), thoracic (middle and upper back), and lumbar (lower back). Each section has a corresponding natural curvature type; the cervical and lumbar spinal sections have an inward C-shaped curvature known as ‘lordosis’, and the thoracic spine has an outward reverse C-shaped curvature known as ‘kyphosis’.
This complex structure of the spine is there for a reason; it gives the spine its strength, flexibility, and facilitates the even distribution of mechanical stress that’s incurred during daily movement.
For an individual to have an economical gait and posture (meaning not requiring excess energy to maintain), the curves in the sagittal plane have to be balanced. An individual’s gravity line should naturally fall through the head, cervical spine, behind the sacrum (pelvis area), and through the center of the hips. If this line of gravity is maintained, a person can easily maintain a straight and upright posture, and a healthy gait, while investing minimal energy.
But that line of gravity can only be maintained if the spine’s natural curvatures are in place and balanced. Once that balance is thrown off, so too is the body’s center of gravity.
A loss of lordosis in the lumbar spine is exactly that: a loss of one of the spine’s natural curvatures, and this affects the other curvatures as it throws off the spine’s overall biomechanics.
A loss of lordosis means there is less of a curvature than there should be, and that section of the spine becomes straighter than it should be as a result; this can lead to the development of a condition known as ‘flatback syndrome’.
Every patient and condition will have their own unique set of characteristics, and while symptoms can vary greatly based on a number of factors such as age, physical fitness, and condition severity, there are some common symptoms of flatback syndrome a person can watch for.
As mentioned, when the spine loses one or more of its healthy and natural curvatures, uneven forces are introduced to the body.
The main symptoms of flatback syndrome are issues of balance and symmetry. For some people with a loss of lumbar lordosis, this can make it difficult to stand upright, especially for long periods of time.
As it takes more energy and active effort to maintain erect posture and gait, something as simple as standing can be a challenge. Often, in addition to low back pain, neck, thigh and groin pain can be an issue for people with flatback syndrome.
Typically, these symptoms can increase throughout the day as the body gets more fatigued from its efforts to adjust to its uneconomical stance and gait. Often, individuals with flatback syndrome will frequently flex and/or bend their knees and hips to help them maintain an upright position, and as the day progresses, this gets increasingly tiring.
In addition, individuals can experience neck and upper back pain resulting from the strain of trying to align themselves. Depending on the severity of the condition, these symptoms can range from mild to severe; once they reach severe levels, the loss of lumbar lordosis and resulting flatback syndrome can interfere with an individual’s ability to perform daily activities.
This leads us into the next logical question of, what causes loss of lumbar lordosis to occur?
As a loss of lumbar lordosis increases and starts to produce symptoms, the development of flatback syndrome is a common result.
Flatback syndrome was first found in patients who had undergone spinal-fusion surgery to correct their scoliosis. Now, this was in the surgery’s earlier days, between the 1960s and 80s, and while there have been significant changes since then, making these problems less common, the surgery is still an invasive procedure with a risk of serious side effects and complications.
Early spinal fusions were performed using Harrington rod instrumentation, and this has since been found to flatten the natural sway of the lumbar spine, particularly in cases where the fusion extended down into the L4 or L5 vertebrae (spinal bones) of the lower lumbar spine.
What was observed in patients who underwent spinal fusion during its early days with Harrington rod instrumentation was that as the natural degenerative effects of aging happened over time, such as intervertebral spinal disc degeneration, issues started to occur below the site of fusion; those peoples’ ability to stand upright became more difficult, leading to pain and discomfort.
Now, in addition to being a potential result of undergoing spinal-fusion surgery, flatback syndrome can also be caused by other factors.
While loss of lumbar lordosis can be the result of undergoing spinal-fusion surgery, it can also be caused by underlying spinal conditions such as degenerative disc disease and ankylosing spondylitis.
In addition, trauma can lead to injury that results in the development of flatback syndrome, and as mentioned earlier, the condition can also develop as a complication of undergoing spinal surgery.
As a person ages, the intervertebral discs of the spine can start to deteriorate. The spine’s intervertebral discs sit between the vertebrae of the spine, helping preserve the spine’s natural curvatures, acting as ligaments holding the spine together, and providing cushioning between adjacent vertebrae so they don’t rub against each other. Basically, the spine’s discs act as the body’s shock absorbers.
When the discs start to erode, the spine can experience a number of symptoms such as pain and stiffness, reduced mobility, and an inability to maintain the spine’s natural and healthy curvatures.
The intervertebral disc degeneration that characterizes degenerative disc disease can cause the spine to flatten out and lose its natural lordosis.
Ankylosing spondylitis is arthritic inflammation of the spine. It’s known to cause stiffness and spinal rigidity. There are different severity levels, and in severe cases, it can lead to the formation of new bone and fusion, referred to as ‘ankylosis’; this can result in sections of the spine becoming fused in a flat fixed position.
When this happens, the spine’s natural lordosis is lost as the affected section becomes flatter.
Vertebral Compression Fractures
As mentioned earlier, vertebrae are the bones of the spine. When one or more of these bones become compressed and collapse, this is known as a ‘vertebral compression fracture’.
Now, this can occur as a result of trauma and injury, but it is most commonly found in older adults with osteoporosis: a condition that substantially weakens the bones.
We already discussed how flatback syndrome can be a complication of undergoing spinal fusion, but it can also be caused by another surgical procedure: laminectomy.
Laminectomies, also called ‘decompression surgery’, are performed on patients who need more space in their spinal canal, most often to relieve pressure on the spinal cord and/or nerves. This is done by removing lamina (back portion of a vertebra covering the spinal canal).
Sometimes, the procedure can lead to a loss of lordosis and the development of flatback syndrome.
People experiencing difficulty standing upright and/or lower back, leg, and hip pain, are frequent indicators of an upcoming flatback-syndrome diagnosis.
A diagnosis is generally reached through a combination of taking a patient’s history, a physical examination, and X-rays of the spine.
As mentioned earlier, prior spinal surgery is often a cause of flatback syndrome, so an important part of taking a patient’s history isn’t just relevant genetic conditions and diseases, but also their surgical history.
In addition to an X-ray of the spine, a doctor might also order an MRI or a CT scan to identify any potential problems with the soft tissues of the spinal cord, nerves, and/or the intervertebral discs; this helps determine the most effective and safest treatment plan moving forward.
While there are patients who opt for surgery before trying other treatment methods first, here at the Scoliosis Reduction Center, we have experience treating a wide variety of complex spinal conditions with a functional approach that can help people avoid invasive procedures.
Here at the Center, the nonsurgical treatment we offer for flatback syndrome involves assessment through physical examination, taking the patient’s full medical history, especially if they have had previous spinal surgery, and, if necessary, taking an X-ray of the full spine in a variety of positions and from a variety of angles.
Next, we fully customize a treatment plan by integrating different treatment disciplines so our patients get the benefit of what each approach offers.
We combine chiropractic adjustments, exercise, and in-office rehabilitation designed to increase the core muscles that support and stabilize the spine, and this would also provide relief for those experiencing related back and/or neck, hip, and leg pain.
By working towards a restoration of as much of the spine’s healthy curvatures as possible, we are improving upon the spine’s biomechanics, and helping to preserve its individual parts and natural curvatures.
A loss of lumbar lordosis can make the muscles of the lower back stiff and tight. While specific exercises don’t have the power, on their own, to induce a structural change, they can effectively stretch and loosen the lower back’s extensor muscles and keep the spine as flexible as possible.
Spine’s that are loose and flexible are also more responsive to treatment, not to mention far less likely to cause back problems for people.
When used in conjunction with other treatment disciplines, as in our integrative and functional approach, specific spinal exercises and stretches can help augment treatment results, strengthen muscles that support the spine, and increase flexibility.
As such an important part of human anatomy, maintaining the spine’s health is crucial to a person’s overall health and wellness.
Not only does the spine allow us to maintain a straight and upright posture, it also facilitates our flexible movement, and together with the brain, it forms the body’s central nervous system.
For the spine to fulfill its many roles, its individual parts and characteristic curvatures have to be preserved for optimal function. The spine has three main sections with each having a related curvature.
The two types of spinal curvatures are known as ‘lordosis’ and ‘kyphosis’. Lordosis refers to the natural C-shaped curvatures of the cervical and lumbar spine, while kyphosis refers to the reverse C-shaped curvature of the thoracic spine.
If there is a loss of one or more of these curvatures, the overall biomechanics of the spine are disrupted as the body tries to adjust to the shift in alignment.
When the lumbar spine develops an under-pronounced lordosis, this means the affected section of the spine has lost its natural curvature, becoming flatter and straighter. When this loss of lumbar lordosis continues and starts to produce symptoms such as an inability to stand upright and related back and/or neck, hip, and leg pain, flatback syndrome can develop.
As is the case with most complex spinal conditions, a loss of lumbar lordosis can have multiple potential causes, one potential cause being the result of spinal-fusion surgery. This is especially the case when the fusion takes place in the lower lumbar spine as the fused section becomes fixed and immovable, although modern advancements in instrumentation used has greatly lessened this occurrence.
Other common causes of a loss of lumbar lordosis include degenerative disc disease, ankylosing spondylitis, vertebral compression fractures, or complications of another surgical procedure: laminectomy.
Here at the Scoliosis Reduction Center, we do our best to reach treatment success through a more natural and functional approach, in order to avoid the hardships and potential complications associated with invasive surgical procedures such as spinal fusion.
If you or a loved one is noticing an increasing difficulty in standing upright, and/or the presence of back, neck, hip, or leg pain, these are common indicators of a loss of lumbar lordosis. If part of your medical history includes previous spinal-fusion surgery, there is a high likelihood that flatback syndrome could be the cause of your symptoms.