Flat Back Syndrome: The Importance of Early Recognition and Intervention: A Case Report

Case Diagnosis: Flat back syndrome

Case Description or Program Description: A 41-year-old male with a history of lumbar spinal stenosis, multiple spine surgeries, and chronic right foot drop presented with worsening posture, right leg weakness, and numbness. He was admitted to inpatient rehabilitation for severe lower back spasms after undergoing L5/S1 anterior lumbar interbody fusion, T9-pelvis posterior spinal fusion revision, and T10-L1 laminectomy. Postsurgical complications included multiple dural tears requiring a lumbar drain and prolonged supine positioning. His hospital course was further complicated by fever, leukocytosis, urinary retention, orthostatic hypotension, and delayed mobilization. Physical exam was notable for wide-based gait, bilateral out-toeing, decreased step length, light touch sensation loss in the right lower extremity, and limited muscle testing due to pain. Pain improved with walking but worsened with immobility.

Setting: Acute Inpatient Rehabilitation

Assessment/Results: X-ray revealed exaggerated kyphosis at the lower thoracic spine near the thoracolumbar junction. Computed tomography showed mild multilevel degenerative disease. Given the diagnosis of flat back syndrome, the patient underwent elective surgical revision.

Discussion (relevance): This abstract represents the first case assessing rehabilitation strategies for flatback syndrome. Encouraging aggressive range of motion exercises and controlling muscle spasms were critical. He was on tizanidine 4mg three times a day and baclofen 10mg twice daily for spasms. Despite our best efforts, he ultimately required surgical correction. While flat back syndrome is a known complication of spinal fusion, postoperative recovery is often delayed due to complications, such as dural tears, orthostatic hypotension, and severe muscle spasms. The lack of literature suggesting a structured rehabilitation approach also posed a challenge.

Conclusions: This case underscores the risk of dural tears and prolonged recovery in revision surgery for flat back syndrome. Early recognition of complications, proactive cerebral spinal fluid leak management, and structured rehabilitation are essential for optimizing functional outcomes. More research is required on how to best optimize patients with this syndrome.