Flatback Syndrome

Ricardo Ferreira, MDRafael Mota, MD

Rio de JaneiroBrazil

RCPV

• 35 year old female• One prior scoliosis surgery ( > 20 Y post-op )• Decompensated forward• Leg / Back pain • Progressive neurogenic claudication

Flat Back

X-Ray

CT

MRI

Flat Back

What we gonna do now ?

I had planned ...• Removal of Harrington rod• L4-5, L5-S1 Laminectomy• Osteotomy of facets and release the old fusion • T4-S1 Pedicular fixation (pedicle screws, rods and hooks)

• Correction to achieve spinal balance• Placement of bone graft

But...After massive blood loss during rod removal and osteotomies

A new surgical strategy :– Removal of Harrington rod – L4-5, L5-S1 Laminectomy– Osteotomy of facets and release of the old fusion ( JUST LUMBAR ) – L1-S1 Pedicular fixation (pedicle screws, rods )

– Correction to increase lumbar lordosis and pelvic balance – Placement of bone graft

In Loco

Post – op

Before & After

Before Before After After

Before & After

Before After

Before & After

Before After