Adult Deformity: Flatback

Case Information

Patient in her 70’s had undergone multiple spinal surgeries from an anterior and a posterior approach.
Patient had removal of her instrumentation and suffered a fracture of the L4 vertebra which placed her in a flatback posture.
The flatback posture is a leaning forward position of the patient. The patient tries to look forward by bending their knees but get fatigued easily in trying to hold that posture. They ultimately lean forward or bend forward again.
She underwent an anterior L5-S1 fusion and an anterior reconstruction of the L4 vertebral body with allograft femoral shaft bone from the bone bank.
The posterior approach was performed in a staged manner on a different day.
Posterior correction was achieved with multiple Ponte osteotomies and a Pedicle Subtraction Osteotomy (PSO).
A Pedicle Subtraction Osteotomy entails removing a wedge of bone from the vertebral body to recreate the lumbar lordosis or swayback. This allows the patient to stand up straight again as seen in the clinical picture after surgery.