Flat back deformity with loss of lumbar lordosis

Flat back deformity secondary to distraction of the lumbar spine in scoliosis surgery was described more than 20 years ago. Increased incidence is seen with increasing age of population and increasing use of pedicle fixation for treatment of degenerative conditions of the lumbar spine. Multiple forms of surgery have been designed to care for this problem, including posterior column osteotomy, staged anterior and posterior osteotomies, and decancelization of both the posterior middle and anterior column osteotomies via posterior approach. This paper outlines the causes of flat back deformity, preoperative planning, various surgical techniques, and their outcomes including complications.