View Full Version : Flatback ? I don't undertand it.

07-01-2011, 08:24 PM
Hello to my wonderful blog community,

I am doing research and reading everything I can before I put my daughter in surgery. I read about several people getting flatback or failed surgery.
Is it the surgeons "mistake" or just something that happens?
Is there any way of avoiding it?
I am very nervous. Sometimes I wonder if I should not read about stuff and just "trust" the doctor like my husband.

We are having surgery with Dr Gupta at Shriners Sac.

Anyhow, I look forward to any information and knowledge shared with me.

07-01-2011, 08:36 PM
Hi Kim...

Flatback is relatively rare in surgeries performed today, but does occur. Getting the right amount of lordosis when a patient is prone is more art than science. There are many reasons why a patient such as your daughter might require additional surgery. I'll look up some studies for you when I get home. You should be scared. This is a big surgery. But, I assume that your daughter really needs surgery. The consequence of not having surgery are probably much worse than flatback or most other complications of surgery. Flatback can be fixed, but pulmonary insufficiency cannot


07-01-2011, 10:19 PM
Hi Kim...

Here's the abstract from the most comprehensive study of complications from AIS surgery:

Spine (Phila Pa 1976). 2011 Jan 5. [Epub ahead of print]
Complications in the Surgical Treatment of 19,360 cases of Pediatric Scoliosis: A Review of the Scoliosis Research Society Database.
Reames DL, Smith JS, Fu KM, Polly DW Jr, Ames CP, Berven SH, Perra JH, Glassman SD, McCarthy RE, Knapp DR Jr, Heary R, Shaffrey CI; Scoliosis Research Society Morbidity and Mortality Committee.

1University of Virginia Medical Center, Department of Neurosurgery, Charlottesville, VA; 2University of Minnesota, Departments of Orthopedic Surgery and Neurosurgery, Minneapolis, MN; 3University of California - San Francisco, Department of Neurosurgery, San Francisco, CA; 4University of California - San Francisco, Department of Orthopedic Surgery, San Francisco, CA; 5Twin Cities Spine Center, Minneapolis, MN; 6Norton Leatherman Spine Center, Louisville, KY; 7Arkansas Spine Center, Little Rock, Arkansas; 8Arnold Palmer Children's Hospital, Orlando, FL; 9Center for Neurological Surgery, UMDNJ, Newark, NJ.

Study Design: Retrospective review of a multicenter database.Objective: To determine the complication rates associated with surgical treatment of pediatric scoliosis and to assess variables associated with increased complication rates.Summary of Background Data: Wide variability is reported for complications associated with the operative treatment of pediatric scoliosis. Limited number of patients, surgeons and diagnoses occur in most reports. The Scoliosis Research Society (SRS) Morbidity and Mortality (M&M) database aggregates deidentified data, permitting determination of complication rates from large numbers of patients and surgeons.Methods: Cases of pediatric scoliosis (age ≤18 years), entered into the SRS M&M database from 2004-2007, were analyzed. Age, scoliosis type, type of instrumentation used, and complications were assessed.Results: 19,360 cases met inclusion criteria. 1,971 total complications (10.2%) occurred. Overall complication rates differed significantly among idiopathic, congenital, and neuromuscular cases (P<0.001). Neuromuscular scoliosis had the highest rate of complications (17.9%), followed by congenital scoliosis (10.6%), and idiopathic scoliosis (6.3%). Rates of neurological deficit also differed significantly based on scoliosis etiology (P<0.001), with the highest rate among congenital cases (2.0%), followed by neuromuscular types (1.1%), and idiopathic scoliosis (0.8%). Neuromuscular scoliosis and congenital scoliosis had the highest rates of mortality (0.3% each), followed by idiopathic scoliosis (0.02%). Higher rates of new neurological deficits were associated with revision procedures (p<0.001) and with the use of corrective osteotomies (p<0.001). The rates of new neurological deficit were significantly higher for procedures utilizing anterior screw only constructs (2.0%) or wire only constructs (1.7%), compared with pedicle screw only constructs (0.7%) (p<0.001).Conclusion: In this review of a large multicenter database of surgically treated pediatric scoliosis, neuromuscular scoliosis had the highest morbidity, but relatively high complication rates occurred in all groups. These data may be useful for pre-operative counseling and surgical decision making in the treatment of pediatric scoliosis.

[PubMed - as supplied by publisher]

There doesn't appear to be any recent literature about flatback in AIS. From what I've seen, I would say it's a very rare complication in AIS, at least using the current generation of implants, and especially when the surgeon has a lot of experience.


07-01-2011, 11:37 PM
Hi Linda,
Im glad you answered my post.
I see, so "flatback" is not the only concern.
So Hailey's is labeled idiopathic.
I forgot to mention. She's 13.
We just got diagnosis in March or April. It came on QUICK.
Since they found it in school and we got the referral to UCD and Shriners, I have watched it's progression with my eyes. Her #'s are 60 upper 39 or something lower. Although by the way I've watched it grow I'll bet it's higher now.
Dr Gupta said she us due to grow another 5-7 inched in puberty which is just now setting in.
We are on some wait list for surgery for July and other date is Sept. She cleared preop already and yes her pulmonary work showed resistance which she said was normal with kids with this curve.
I appreciate your replys!!

07-02-2011, 03:11 AM
Kim like linda said flatback is rare is AIS.