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Thread: Flat Back

  1. #1
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    Unhappy Flat Back



    Hi all...
    Haven't written in years, but I have had flatback since my original lower back surgery/fusion in 2005. It has been the bane of my existence, and I think about it constantly as it only hurts when I try to walk or stand upright without support, and for any length of time, haha. Of course I'm grateful that sitting mostly alleviates the discomfort, of course I know "it could have been worse", but losing the ability to just walk around the block--or even across a room without constantly fighting the pushed forward feel and muscle ache/strain is the source of most of my depression. I used to LOVE walking all over the place and did. I am now envious of those I see in real life, TV, etc. so easily enjoying what is no longer part of my life. I always thought it was something that would improve with time. I also developed kyphosis above the original lower surgery and fusion, and had a surgery/fusion for that with a different doc 5 years to the day of the original--so 2010. I somehow thought back then that that would also address the flatback, but of course it did not. I guess I handled all this better when I had the support of my former spouse.

    Just wondering if anyone has had a good correction surgery, and if the recovery etc, is as harrowing as the others. I'm hoping maybe some advances in procedures make it a viable option for me especially at the ripe old age of 69. I am going to talk with my original surgeon Dr Mike Fry in Carson City, Nv. in a few months when he is available, and see what he has to say, though I have brought this up many years ago, and he always seemed to brush it off, never really acknowledging the saggital imbalance/flatback.
    Also wondering if my result is just "the nature of the beast" --a complicated surgical fusion, or if less than ideal outcomes indicate one's doctor is inadequate somehow. I suspect he's not keen on the discussion as that would be admitting he didn't get it quite right. I'm trying to get it into my head (and accept it) that this is how I will be, and just let it be. So, I'll do all I feel I can, then see what my options are.

    Any comments would be greatly appreciated!
    Sharon C.
    Singing the Blues
    Female 1951
    A/P Surgery Oct 13th & 17th '05, from T7-L5, 46 degree curve reduced to 19 degrees. Rib hump almost gone, but I have flatback. Thought it was "normal" and I would improve over time. I developed kyphosis above the surgical area. Had surgery with Dr Menmuir in Reno, Nv on October 13, 2010.
    Today I am still plagued with flatback, and I'm considering ALIF surgery.

  2. #2
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    Sep 2003
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    Northern California
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    Quote Originally Posted by Sharon C View Post

    Hi all...
    Haven't written in years, but I have had flatback since my original lower back surgery/fusion in 2005. It has been the bane of my existence, and I think about it constantly as it only hurts when I try to walk or stand upright without support, and for any length of time, haha. Of course I'm grateful that sitting mostly alleviates the discomfort, of course I know "it could have been worse", but losing the ability to just walk around the block--or even across a room without constantly fighting the pushed forward feel and muscle ache/strain is the source of most of my depression. I used to LOVE walking all over the place and did. I am now envious of those I see in real life, TV, etc. so easily enjoying what is no longer part of my life. I always thought it was something that would improve with time. I also developed kyphosis above the original lower surgery and fusion, and had a surgery/fusion for that with a different doc 5 years to the day of the original--so 2010. I somehow thought back then that that would also address the flatback, but of course it did not. I guess I handled all this better when I had the support of my former spouse.

    Just wondering if anyone has had a good correction surgery, and if the recovery etc, is as harrowing as the others. I'm hoping maybe some advances in procedures make it a viable option for me especially at the ripe old age of 69. I am going to talk with my original surgeon Dr Mike Fry in Carson City, Nv. in a few months when he is available, and see what he has to say, though I have brought this up many years ago, and he always seemed to brush it off, never really acknowledging the saggital imbalance/flatback.
    Also wondering if my result is just "the nature of the beast" --a complicated surgical fusion, or if less than ideal outcomes indicate one's doctor is inadequate somehow. I suspect he's not keen on the discussion as that would be admitting he didn't get it quite right. I'm trying to get it into my head (and accept it) that this is how I will be, and just let it be. So, I'll do all I feel I can, then see what my options are.

    Any comments would be greatly appreciated!
    Sharon C.
    Hi Sharon...

    Correction of flatback is relatively common for the surgeons who perform a lot of complex spine surgery, even for older individuals. I don't know if it's a possibility for you, but I would recommend that you try to get in to see either Dr. Sigurd Berven or Dr. Vedat Deviren at UCSF. They both have a lot of experience with correction of flatback.

    --Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  3. #3
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    Is flat back possible after a full fusion?

  4. #4
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    May 2008
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    reno,nevada
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    Sharon, Long time no C....

    Dr Menmuir went to Florida, and Dr Halki was my other scoliosis surgeon. That would be another "local" option for an opinion. Chances are Dr Halki was there for your PJK extension years ago as both operated in pairs. I saw Dr M when my neck reared its ugly neck in 2013 so it's been 8 years. Both are not at Reno Orthopedic anymore.

    If you go out of state you have to address insurance. Leaving your home state can get extremely expensive. I would address ALL co-pays on the phone (even in Nevada) before doing anything. The whole insurance situation is not like it was years ago....

    I don't remember you leaning forward, but we do hide things so well when we have to.....(Up until 8PM of course!).

    Remember eating at that restaurant in Dayton across the street from where Marilyn Monroe and Clark Gable did the bar scene in The Misfits 1961? I think that was after your PJK procedure but not sure.
    https://www.movie-locations.com/movies/m/Misfits.php

    Getting old with scoliosis is not easy....I am worrying about traveling these days with my neck.


    Ed
    49 yr old male, now 62, the new 63...
    Pre surgery curves T70,L70
    ALIF/PSA T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  5. #5
    Join Date
    Feb 2005
    Location
    Carson City, Nv
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    Quote Originally Posted by LindaRacine View Post
    Hi Sharon...

    Correction of flatback is relatively common for the surgeons who perform a lot of complex spine surgery, even for older individuals. I don't know if it's a possibility for you, but I would recommend that you try to get in to see either Dr. Sigurd Berven or Dr. Vedat Deviren at UCSF. They both have a lot of experience with correction of flatback.

    --Linda
    Thanks Linda. I don't know if SF is a possibility for me either, as I'm not sure about insurance and the other logistics, but I sure appreciate your suggestions!
    Singing the Blues
    Female 1951
    A/P Surgery Oct 13th & 17th '05, from T7-L5, 46 degree curve reduced to 19 degrees. Rib hump almost gone, but I have flatback. Thought it was "normal" and I would improve over time. I developed kyphosis above the surgical area. Had surgery with Dr Menmuir in Reno, Nv on October 13, 2010.
    Today I am still plagued with flatback, and I'm considering ALIF surgery.

  6. #6
    Join Date
    Feb 2005
    Location
    Carson City, Nv
    Posts
    84
    Quote Originally Posted by titaniumed View Post
    Sharon, Long time no C....

    Dr Menmuir went to Florida, and Dr Halki was my other scoliosis surgeon. That would be another "local" option for an opinion. Chances are Dr Halki was there for your PJK extension years ago as both operated in pairs. I saw Dr M when my neck reared its ugly neck in 2013 so it's been 8 years. Both are not at Reno Orthopedic anymore.

    If you go out of state you have to address insurance. Leaving your home state can get extremely expensive. I would address ALL co-pays on the phone (even in Nevada) before doing anything. The whole insurance situation is not like it was years ago....

    I don't remember you leaning forward, but we do hide things so well when we have to.....(Up until 8PM of course!).

    Remember eating at that restaurant in Dayton across the street from where Marilyn Monroe and Clark Gable did the bar scene in The Misfits 1961? I think that was after your PJK procedure but not sure.
    https://www.movie-locations.com/movies/m/Misfits.php

    Getting old with scoliosis is not easy....I am worrying about traveling these days with my neck.


    Ed
    Just left a full response that magically disappeared....C'est la Vie!

    Yes Ed, I remember the restaurant, and also your visit to Renown after my second surgery, where Dr Menmuir kindly removed some floating screws that were giving me grief from my first surgery. Think I sent you the picture of you posing with one next to me in my hospital bed. Fun times! Not sure what "PJK" procedure means, but I'm impressed that I apparently survived it!
    Glad you are still kickin' and dispensing your considerable scoli knowledge here. I'm thinking my only option would be to find someone local, or scrap the whole idea, as I don't have the means and/or support to go gallivanting far and wide. I'll see about contacting Dr Halki if he is well versed in this type of revision. Don't know what else I can do.
    Yep--few know I lean forward as I don't let myself in public--if I can help it, or after 8pm, of course ;-)

    Be well,
    Sharon
    Singing the Blues
    Female 1951
    A/P Surgery Oct 13th & 17th '05, from T7-L5, 46 degree curve reduced to 19 degrees. Rib hump almost gone, but I have flatback. Thought it was "normal" and I would improve over time. I developed kyphosis above the surgical area. Had surgery with Dr Menmuir in Reno, Nv on October 13, 2010.
    Today I am still plagued with flatback, and I'm considering ALIF surgery.

  7. #7
    Join Date
    Sep 2003
    Location
    Northern California
    Posts
    7,211
    Quote Originally Posted by Tina_R View Post
    Is flat back possible after a full fusion?
    Yes
    https://thejns.org/focus/view/journa...20back%20pain.
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  8. #8
    Join Date
    May 2008
    Location
    reno,nevada
    Posts
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    I remember coming down to the hospital since your room in the new wing at Renown was puurtty nice.... I thought I was checked in at the Westin in the Presidential suite out at Kaanapali Beach in Maui.

    PJK or Proximal Junctional Kyphosis is the falling forward of the spine above a spinal fusion. This can happen, and is no fault due to the prior surgeon's work. Its less surgery, and spares the gripping or bear traps of full fusions up high in the thoracic so it's worth a shot. Sometimes we have to have extensions up high in the spine, and that's what you had done....

    Was it Dr Menmuir who told you about the flatback?

    Your fused down to L5. I wonder if you are pitched forward down low.....the L5-S1 can be critical as it supports the whole fusion mass....Many of us have the pelvic anchors all the way at the bottom, those are the big screws that wing off to the side. You can see these on my x-rays in my signature.

    I am not sure if Dr Halki is used to doing these types of revision surgeries....Dr Berven sure is, there is no doubt about that.

    Dr Halki might be able to help out without any surgeries but the only way to know is to go in.

    I would be more than happy to join you if you see Dr Halki. The thing is that COVID makes this too complicated.

    Ed
    49 yr old male, now 62, the new 63...
    Pre surgery curves T70,L70
    ALIF/PSA T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  9. #9
    Join Date
    Feb 2005
    Location
    Carson City, Nv
    Posts
    84

    Cool

    Quote Originally Posted by titaniumed View Post
    I remember coming down to the hospital since your room in the new wing at Renown was puurtty nice.... I thought I was checked in at the Westin in the Presidential suite out at Kaanapali Beach in Maui.

    PJK or Proximal Junctional Kyphosis is the falling forward of the spine above a spinal fusion. This can happen, and is no fault due to the prior surgeon's work. Its less surgery, and spares the gripping or bear traps of full fusions up high in the thoracic so it's worth a shot. Sometimes we have to have extensions up high in the spine, and that's what you had done....

    Was it Dr Menmuir who told you about the flatback?

    Your fused down to L5. I wonder if you are pitched forward down low.....the L5-S1 can be critical as it supports the whole fusion mass....Many of us have the pelvic anchors all the way at the bottom, those are the big screws that wing off to the side. You can see these on my x-rays in my signature.

    I am not sure if Dr Halki is used to doing these types of revision surgeries....Dr Berven sure is, there is no doubt about that.

    Dr Halki might be able to help out without any surgeries but the only way to know is to go in.

    I would be more than happy to join you if you see Dr Halki. The thing is that COVID makes this too complicated.

    Ed
    Haha! Yes, I remember you commenting on the nice digs. Too bad we can't appreciate them as much as we might in that situation, but it was MUCH better than what I had at the old CTH with the first week long surgery--before they tore the place down. Just an awful, noisy room with someone practically convalescing in the same bed with you! Mostly good staff though, so thank goodness for that.
    So kind of you to offer to accompany me to see Dr Halki! It helps so much to have an extra set of ears when we are in the stress of a doctor visit. And you have so much more knowledge and attention to detail than I have. Yes, damn plague anyway. I have had both vaccs though, and do follow all the protocols, so maybe by the time I could see him it would work. I'll swing for lunch!
    Singing the Blues
    Female 1951
    A/P Surgery Oct 13th & 17th '05, from T7-L5, 46 degree curve reduced to 19 degrees. Rib hump almost gone, but I have flatback. Thought it was "normal" and I would improve over time. I developed kyphosis above the surgical area. Had surgery with Dr Menmuir in Reno, Nv on October 13, 2010.
    Today I am still plagued with flatback, and I'm considering ALIF surgery.

  10. #10
    Join Date
    Feb 2005
    Location
    Carson City, Nv
    Posts
    84

    Forgot...

    I actually brought the flatback issue up with Dr Menmuir when I found that the upper surgery didn't improve my "pushed forward" feel. He said no, his surgery didn't address that, and he didn't "recommend" getting it done back then. I'm assuming he felt that I had already been pretty lucky escaping pain that could not be mostly relieved by a change of position/sitting, and or paraplegia, god forbid. Also might not have been comfortable correcting another doctor's work--or confident he could--who knows.

    I had done research on my symptoms and found them in described to a tee, in black and white online, where we all get our expert medical advice these days! Ha! It was both a blessing---and a curse, because what would I do NOW?

    Mark and I were both plenty done with the whole surgical affair, and of course other life issues crop up that become the priority.
    Singing the Blues
    Female 1951
    A/P Surgery Oct 13th & 17th '05, from T7-L5, 46 degree curve reduced to 19 degrees. Rib hump almost gone, but I have flatback. Thought it was "normal" and I would improve over time. I developed kyphosis above the surgical area. Had surgery with Dr Menmuir in Reno, Nv on October 13, 2010.
    Today I am still plagued with flatback, and I'm considering ALIF surgery.

  11. #11
    Join Date
    Sep 2003
    Location
    Northern California
    Posts
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    Quote Originally Posted by titaniumed View Post
    PJK or Proximal Junctional Kyphosis is the falling forward of the spine above a spinal fusion. This can happen, and is no fault due to the prior surgeon's work. Its less surgery, and spares the gripping or bear traps of full fusions up high in the thoracic so it's worth a shot.
    None of that is absolute.
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  12. #12
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    Sep 2019
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    Quote Originally Posted by LindaRacine View Post
    Wow. How is that possible? The metal rods would have to bend, wouldn't they?

  13. #13
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    illinois
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    No the rods do not have to break or bend. The rods are strong but the need for perfect balance is even stronger so the rods and screws are pulled upon.
    There could be a nonunion also.that is what happened to me. It did not show on X-Ray but did show on a myelogram.
    T10-pelvis fusion 12/08
    C5,6,7 fusion 9/10
    T2--T10 fusion 2/11
    C 4-5 fusion 11/14
    Right scapulectomy 6/15
    Right pectoralis major muscle transfer to scapula
    To replace the action of Serratus Anterior muscle 3/16
    Broken neck 9/28/2018
    Emergency surgery posterior fusion C4- T3
    Repeated 11/2018 because rods pulled apart added T2 fusion
    Removal of partial right thoracic hardware 1/2020
    Removal and replacement of C4-T10 hardware with C7 and T 1
    Osteotomy

  14. #14
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    Sep 2019
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    Quote Originally Posted by jackieg412 View Post
    No the rods do not have to break or bend. The rods are strong but the need for perfect balance is even stronger so the rods and screws are pulled upon.
    There could be a nonunion also.that is what happened to me. It did not show on X-Ray but did show on a myelogram.
    But if your back literally flattens and loses its curve it has to change shape. How can this happen if the spine and the rods don't bend?

  15. #15
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    Quote Originally Posted by Tina_R View Post
    Wow. How is that possible? The metal rods would have to bend, wouldn't they?
    Iatrogenic flatback is caused by a lack of perfect sagittal balance created during spinal fusion procedures. It's a very complex calculation, and even the very best surgeons create some amount of this problem.

    Sagittal balance is a complex equation that involves every part of your spine and pelvis, and is unique to each individual. If you want to try to figure it out, check out section 2 on THIS page. There are many spine surgeons who have no clue how to get it right, so I suspect there are few lay people (including me), who really understand it completely.

    In addition to iatrogenic flatback, there is some discussion about the possibility that soft tissue may play a role. If you were to view my xrays, I have almost perfect parameters for a balanced spine. However, I am definitely pitched forward when I walk. This is not an uncommon phenomenon, and seems to occur more in elderly patients.

    --Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

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