{"id":9059,"date":"2026-08-07T12:00:00","date_gmt":"2026-08-07T10:00:00","guid":{"rendered":"https:\/\/complexspineinstitute.com\/sin-categoria\/flat-back-in-adults-signs-and-diagnosis\/"},"modified":"2026-08-06T18:54:42","modified_gmt":"2026-08-06T16:54:42","slug":"flat-back-in-adults-signs-and-diagnosis","status":"publish","type":"post","link":"https:\/\/complexspineinstitute.com\/en\/neurosurgery-blog\/flat-back-in-adults-signs-and-diagnosis\/","title":{"rendered":"Flat back in adults: signs and diagnosis"},"content":{"rendered":"<p><strong>Flat back in adults is not the same as \u201chaving poor posture.\u201d When lumbar lordosis \u2014the inward curve of the lower back\u2014 is significantly lost, the body no longer balances well over the pelvis and the person may begin to walk leaning forward, tire when standing and need to bend the knees or hips to compensate. Recognizing flat back in adults early helps distinguish a reversible postural alteration from a true sagittal deformity, which is a structural spinal alignment problem.<\/strong><\/p>\n<ul style=\"margin-bottom:16px;line-height:1.7\">\n<li>Flat back in adults involves loss of lumbar lordosis.<\/li>\n<li>It can cause fatigue when standing and walking.<\/li>\n<li>It is not always obvious on a quick exam.<\/li>\n<li>Standing radiographs are key.<\/li>\n<li>Treatment depends on symptoms and cause.<\/li>\n<li>Surgery is reserved for selected cases.<\/li>\n<li>If there is weakness or loss of balance, prompt assessment is required.<\/li>\n<\/ul>\n<h2 id=\"que-es-y-por-que-ocurre\" style=\"margin-top:32px;margin-bottom:12px\">What flat back in adults is and why it happens<\/h2>\n<p style=\"margin-bottom:16px;line-height:1.7\"><strong>Flat back<\/strong> in adults, also called <strong>flatback syndrome<\/strong>, describes a condition in which the lumbar spine loses part of its normal inward curvature, known as <strong>lumbar lordosis<\/strong>. Lordosis is a physiological curve\u2014normal and necessary\u2014that helps distribute loads, keep the trunk balanced and save energy when walking and standing. When that curve decreases too much, the body must compensate with changes in the pelvis, hips, knees and trunk.<\/p>\n<p style=\"margin-bottom:16px;line-height:1.7\">In practice, <strong>flat back in adults<\/strong> is not an aesthetic label. It is an alteration of sagittal balance, that is, the alignment of the body seen in profile. A person may appear \u201cstooped\u201d or tilted forward at the end of the day, not simply because their shoulders are rounded, but because their body axis no longer falls efficiently over the base of support. That loss of efficiency explains why walking and standing become more costly and often painful.<\/p>\n<p style=\"margin-bottom:16px;line-height:1.7\">Causes are varied. In some adults, flat back appears after prior spinal surgeries, especially when a lumbar fusion has not properly restored lordosis or when a deformity has been inadequately corrected. In other cases it is related to degeneration of the intervertebral discs, arthritis of the posterior joints, prior spondylolisthesis, fragility fractures or adult deformities that progress over the years. Loss of lordosis can also occur without prior surgery, due to progressive stiffness and accumulated degenerative changes.<\/p>\n<p style=\"margin-bottom:16px;line-height:1.7\">It is important to understand that flat back in adults does not necessarily mean a complete absence of curve. Sometimes the problem is <strong>insufficient lordosis<\/strong> for that person\u2019s biomechanical needs. In fact, the important issue is not only how much curve there is, but whether there is balance between pelvic anatomy and spinal shape. Therefore two patients with the same X-ray may not feel the same or require the same treatment.<\/p>\n<h2 id=\"sintomas-y-senales-de-alarma\" style=\"margin-top:32px;margin-bottom:12px\">Symptoms and warning signs<\/h2>\n<p style=\"margin-bottom:16px;line-height:1.7\">The most characteristic symptom of flat back in adults is the <strong>sensation of leaning forward<\/strong> when standing or walking. Many people report that they need to \u201csearch for their posture,\u201d rest their hands on their thighs, slightly flex their knees or sit frequently to relieve tension. Others notice they can no longer stand upright for as long as before, or that their posture worsens markedly by the end of the day.<\/p>\n<p style=\"margin-bottom:16px;line-height:1.7\">Unlike simple poor postural habits, a true sagittal deformity is often accompanied by <strong>muscle fatigue<\/strong>, mechanical low back pain, stiffness and, sometimes, pain in the buttocks or thighs when standing for prolonged periods. Some people describe their back as \u201cpulling\u201d them forward, as if the body needs to find a resting position to stop wasting energy. That postural fatigue is a very useful clue because it typically worsens with long distances, queues, standing at the sink, household tasks or prolonged walks.<\/p>\n<p style=\"margin-bottom:16px;line-height:1.7\">Visible compensations may also appear. It is common to see a pelvis rotated backward, slightly flexed hips, semiflexed knees and a forward trunk. Over time, those compensations can produce pain in the low back, hip or knees or even a slower, less efficient gait. The person does not always report \u201csevere pain,\u201d but does have a clear functional loss: difficulty standing, walking less, stopping sooner and avoiding activities previously tolerated.<\/p>\n<p style=\"margin-bottom:16px;line-height:1.7\"><strong>Warning signs<\/strong> that require more prompt medical evaluation include the onset of leg weakness, repeated falls, progressive numbness, loss of bowel or bladder control, very intense recent pain, history of trauma, fever or disproportionate night pain. Although not all of these situations mean a life-threatening emergency, they can indicate that flat back in adults is part of a more complex problem that needs directed study.<\/p>\n<p style=\"margin-bottom:16px;line-height:1.7\">An important point is that clinical symptoms do not always correlate linearly with the magnitude of curvature. Some people with large loss of lordosis adapt for years, while others with moderate alterations feel severely limited. Therefore evaluation must integrate symptoms, physical examination and imaging, and should not be based only on a photograph or the subjective impression of being \u201cstraight\u201d or \u201cstooped.\u201d<\/p>\n<h2 id=\"como-se-diagnostica\" style=\"margin-top:32px;margin-bottom:12px\">How flat back in adults is diagnosed<\/h2>\n<p style=\"margin-bottom:16px;line-height:1.7\">Diagnosis begins with a detailed <strong>medical history<\/strong>. The specialist asks when the limitation began, whether there was prior lumbar surgery, whether there are fractures, which activities worsen symptoms and whether the patient needs to flex hips or knees to walk or stand. They also check for radiating pain, tingling, weakness or changes in gait. This part is essential because flat back in adults is not diagnosed by imaging alone, but by the relationship between anatomy and function.<\/p>\n<p style=\"margin-bottom:16px;line-height:1.7\">The <strong>physical examination<\/strong> assesses profile posture, spinal mobility, strength, reflexes, sensation and compensation patterns. A very useful clinical finding is to check whether the patient can straighten up voluntarily or requires much effort to do so. It is also observed whether the pelvis is rotated backward, if hamstring tightness is present and whether the knees flex when standing up. These findings point toward a true sagittal deformity, not merely a relaxed posture.<\/p>\n<p style=\"margin-bottom:16px;line-height:1.7\">The essential imaging test is the <strong>standing spine radiograph<\/strong>, i.e., weight-bearing, upright X-rays. In this context, the radiograph is not intended just to \u201csee bones\u201d but to measure sagittal alignment parameters. Key measures include lumbar lordosis, pelvic tilt and how the trunk sits relative to the pelvis. In many cases full-spine radiographs are requested to understand global balance, because the problem is not always confined to the lumbar region.<\/p>\n<p style=\"margin-bottom:16px;line-height:1.7\"><strong>Magnetic resonance imaging<\/strong> helps evaluate discs, nerves, canal stenosis and soft tissues, especially if there is radicular pain, loss of strength or suspicion of nerve compression. <strong>Computed tomography<\/strong> can be useful to study bony detail, plan surgery or review a prior fusion. In some patients additional spinopelvic balance studies are used to understand how much the pelvis is compensating and whether the deformity is flexible or rigid.<\/p>\n<p style=\"margin-bottom:16px;line-height:1.7\">The most important thing is not to confuse a \u201cnice\u201d radiograph with a good diagnosis. Flat back in adults can be more evident standing than lying down, and therefore a supine image does not always reflect the functional reality. The goal is to identify whether the loss of lordosis is altering body balance and explaining the patient\u2019s symptoms.<\/p>\n<h2 id=\"tratamiento-no-quirurgico\" style=\"margin-top:32px;margin-bottom:12px\">Non-surgical treatment options<\/h2>\n<p style=\"margin-bottom:16px;line-height:1.7\">When symptoms are mild to moderate and there is no rigid or progressive deformity, conservative treatment can be the first step. This includes <strong>postural education<\/strong>, activity modification, physical therapy and a tailored exercise program. The aim is not to \u201cforcefully straighten\u201d a structurally altered spine but to improve effort tolerance, reduce pain and optimize compensations.<\/p>\n<p style=\"margin-bottom:16px;line-height:1.7\"><strong>Physical therapy<\/strong> usually focuses on hip mobility, trunk control, endurance of the extensor muscles and gait retraining. Hamstrings and hip flexors may also be addressed, as their tightness can worsen a forward-leaning posture. In many patients regular exercise improves pain and function, although it may not reverse a fixed deformity. Evidence on exercise for chronic low back pain supports its usefulness as part of conservative management, especially when individualized.<\/p>\n<p style=\"margin-bottom:16px;line-height:1.7\"><strong>Analgesics<\/strong> and anti-inflammatory drugs can be used in specific periods to facilitate activity, always weighing gastrointestinal, renal and cardiovascular risks. In some cases injections are used if facet pain, localized inflammation or a radicular component coexist. However, these treatments relieve pain but do not correct loss of lordosis by themselves. Therefore they are useful as adjuncts, not as structural solutions.<\/p>\n<p style=\"margin-bottom:16px;line-height:1.7\"><strong>Braces or supports<\/strong> may have a limited role in selected patients, mainly for short periods or specific situations, but should not be seen as a permanent correction. Similarly, ergonomics helps: distributing loads, avoiding long uninterrupted standing, adjusting work surface heights and planning breaks when postural fatigue is significant. All of this can improve quality of life while studies are completed or the next step is decided.<\/p>\n<h2 id=\"alternativas-quirurgicas\" style=\"margin-top:32px;margin-bottom:12px\">Surgical options<\/h2>\n<p style=\"margin-bottom:16px;line-height:1.7\">Surgery is considered when flat back in adults causes persistent pain, significant functional disability, inability to remain upright or walk normally, or when there is a rigid deformity that does not respond to conservative treatment. It may also be considered if there is neurological compromise or progressive sagittal balance deterioration. The decision does not depend only on a radiographic number but on the relationship between symptoms, deformity flexibility, surgical history and the patient\u2019s general condition.<\/p>\n<p style=\"margin-bottom:16px;line-height:1.7\">The surgical goal is to <strong>restore balance<\/strong>, not just to \u201cmake the back straight.\u201d That may require releasing rigid structures, correcting the lumbar angle and, in some cases, performing an <strong>osteotomy<\/strong>, a controlled bone cut to change alignment. Depending on the case, this may be combined with new instrumentation using screws and rods, revision of a previous fusion or interbody techniques to recover height and lordosis at specific segments.<\/p>\n<p style=\"margin-bottom:16px;line-height:1.7\">Minimally invasive techniques can be useful in selected deformities, but not all flat backs are candidates for small surgeries. When lordosis loss is significant or the deformity is fixed, a more complex reconstruction may be required. In these scenarios preoperative planning is crucial because the aim is to correct alignment in a proportionate and safe way, avoiding both undercorrection and overcorrection.<\/p>\n<p style=\"margin-bottom:16px;line-height:1.7\">Revision surgery after prior operations deserves special mention. Sometimes flat back in adults appears or worsens after an old lumbar fusion, and the problem is not only pain but progressive loss of balance. In that context the study must assess whether the fusion is consolidated, whether pseudoarthrosis exists (i.e., lack of bony union), whether hardware failure is present or whether the body\u2019s global compensation is exhausted. Not all revisions pursue the same target, but they share a principle: correct the real mechanical cause.<\/p>\n<h2 id=\"beneficios-riesgos-efectos-adversos\" style=\"margin-top:32px;margin-bottom:12px\">Benefits, risks and adverse effects<\/h2>\n<p style=\"margin-bottom:16px;line-height:1.7\">The main potential benefit of appropriately indicated treatment is recovering a more efficient posture, reducing fatigue while standing, improving walking capacity and relieving mechanical pain. In selected patients correcting alignment can result in a marked improvement in quality of life because the body spends less energy to remain balanced. This is particularly relevant when flat back in adults limits basic activities such as cooking, queuing, walking or standing during meetings.<\/p>\n<p style=\"margin-bottom:16px;line-height:1.7\">Conservative treatment carries low risks, although it can be frustrating if the patient expects a structural correction that is unrealistic. Poorly directed or overly aggressive physical therapy can increase pain, and medications have known adverse effects. Therefore it is advisable to individualize the plan and review response with functional criteria, not only the perception of \u201cfeeling less pain today.\u201d<\/p>\n<p style=\"margin-bottom:16px;line-height:1.7\">Surgery, on the other hand, can offer greater correction but also carries significant risks: bleeding, infection, neurological injury, thrombosis, postoperative pain, hardware failure, pseudoarthrosis and, in some cases, problems at adjacent levels. The more complex the deformity, the more important planning and the experience of the treating team. In patients with fragile bone, osteoporosis or comorbidities, risk must be weighed carefully.<\/p>\n<p style=\"margin-bottom:16px;line-height:1.7\">Functional adverse effects also exist. Insufficient correction may leave residual symptoms; excessive correction may cause discomfort elsewhere or lead to decompensation. Thus the goal is not a \u201cperfect\u201d spine on an image but an alignment the patient can sustain with less pain and greater stability. In sagittal deformity, outcome quality depends both on technique and case selection.<\/p>\n<h2 id=\"criterios-derivacion-especialista\" style=\"margin-top:32px;margin-bottom:12px\">Referral criteria to a specialist<\/h2>\n<p style=\"margin-bottom:16px;line-height:1.7\">Referral to a specialized unit is advisable when there is <strong>clear functional limitation<\/strong>, persistent pain that does not improve with basic measures, suspicion of sagittal deformity, worsening after prior lumbar surgery, or the need to lean the trunk forward to walk or stand to relieve symptoms. It should also be considered earlier if the patient requires increasing compensations to remain upright.<\/p>\n<p style=\"margin-bottom:16px;line-height:1.7\">Another important criterion is the presence of <strong>neurological symptoms<\/strong> such as weakness, persistent tingling, loss of balance or falls. Flat back in adults can coexist with lumbar stenosis, multilevel degeneration or problems in a prior fusion, which changes the strategy. Early referral prevents the deformity from progressing until it becomes more rigid and complex to correct.<\/p>\n<p style=\"margin-bottom:16px;line-height:1.7\">A specialist evaluation is also warranted for a person who says \u201cI can\u2019t stand up straight anymore,\u201d \u201cI only manage to stand if I lean forward\u201d or \u201cI walk looking at the ground.\u201d These phrases often reflect a problem rather than simple posture. If there is also loss of height, marked mechanical pain, history of fracture or osteoporosis, the assessment should be more complete. In summary, referral is justified when flat back in adults stops being a suspicion and begins to have a sustained impact on function.<\/p>\n<h2 id=\"tiempos-recuperacion\" style=\"margin-top:32px;margin-bottom:12px\">Realistic recovery times<\/h2>\n<p style=\"margin-bottom:16px;line-height:1.7\">With conservative treatment, changes are usually assessed over weeks or months. Physical therapy and exercise require consistency, and improvement tends to be gradual. The initial aim is to reduce pain, improve tolerance to an upright posture and increase walking capacity without fatigue. If the deformity is structural, functional recovery may be partial but still clinically relevant.<\/p>\n<p style=\"margin-bottom:16px;line-height:1.7\">After surgery for flat back in adults, recovery is slower and varies greatly depending on correction complexity, number of fused levels and the patient\u2019s overall condition. In the first weeks pain control and progressive mobilization predominate. Later, autonomy for basic activities is recovered, and bone consolidation takes months. In complex deformities, returning to a fully active life may require a prolonged period and is measured in phased evolution rather than days.<\/p>\n<p style=\"margin-bottom:16px;line-height:1.7\">It is important to explain that improvement does not mean recovery \u201call at once.\u201d In these processes patients typically first notice they tire less when standing, then that they walk better and finally that their confidence in moving increases. Realistic expectations help avoid disappointment and allow identification of what progress is normal at each stage.<\/p>\n<h2 id=\"urgencias\" style=\"margin-top:32px;margin-bottom:12px\">When to go to the emergency department<\/h2>\n<p style=\"margin-bottom:16px;line-height:1.7\">There are situations in which flat back in adults can stop being a mechanical issue and become an urgent medical priority. Seek emergency care if sudden leg weakness appears, repeated falls, sudden inability to walk, loss of bladder or bowel control, numbness in the genital area or very intense pain after a fall or blow. These symptoms can indicate neurological injury, fracture or significant compression.<\/p>\n<p style=\"margin-bottom:16px;line-height:1.7\">Pain accompanied by fever, chills, poor general condition or recent infection history also requires urgent evaluation, as does persistent night pain that does not subside and worsens. In patients with osteoporosis, new intense pain after minimal effort may suggest a vertebral fracture. And if the trunk progressively leans with rapidly worsening balance, do not wait for the next scheduled review.<\/p>\n<h2 id=\"mitos-y-realidades\" style=\"margin-top:32px;margin-bottom:12px\">Myths and realities<\/h2>\n<h3 style=\"margin-top:24px;margin-bottom:8px\">Myth: \u201cHaving a straight back is normal\u201d<\/h3>\n<p style=\"margin-bottom:16px;line-height:1.7\">Reality: a healthy spine is not perfectly straight like a ruler. It has physiological curves, and lumbar lordosis is one of them. Flat back in adults occurs when that curve is excessively lost and balance is affected.<\/p>\n<h3 style=\"margin-top:24px;margin-bottom:8px\">Myth: \u201cIf I stretch a bit, it will fix itself\u201d<\/h3>\n<p style=\"margin-bottom:16px;line-height:1.7\">Reality: a momentary poor posture can improve by correcting habits, but a structural sagittal deformity does not disappear just by \u201cstanding up straight.\u201d Sometimes the load can be relieved, but the loss of lordosis is not necessarily reversed.<\/p>\n<h3 style=\"margin-top:24px;margin-bottom:8px\">Myth: \u201cIf it doesn\u2019t hurt much, it\u2019s not important\u201d<\/h3>\n<p style=\"margin-bottom:16px;line-height:1.7\">Reality: some people with flat back in adults compensate for years and the main problem is fatigue, a forward-leaning gait or functional limitation. Pain does not always reflect the magnitude of the alteration.<\/p>\n<h3 style=\"margin-top:24px;margin-bottom:8px\">Myth: \u201cA lying X-ray is enough to know\u201d<\/h3>\n<p style=\"margin-bottom:16px;line-height:1.7\">Reality: to study spinal balance, standing imaging is key. Flat back in adults manifests mainly under load, when the body must support itself against gravity.<\/p>\n<h3 style=\"margin-top:24px;margin-bottom:8px\">Myth: \u201cSurgery always leaves the back perfect\u201d<\/h3>\n<p style=\"margin-bottom:16px;line-height:1.7\">Reality: surgery aims to improve alignment, function and pain but cannot promise an ideal spine or eliminate all risks. Outcome depends on anatomy, deformity rigidity and the patient\u2019s condition.<\/p>\n<h3 style=\"margin-top:24px;margin-bottom:8px\">Myth: \u201cThis only happens to older people\u201d<\/h3>\n<p style=\"margin-bottom:16px;line-height:1.7\">Reality: although more common with age or after prior surgery, loss of lordosis can also occur in relatively young adults, especially if there is a prior fusion, deformity or significant degeneration.<\/p>\n<h2 id=\"preguntas-frecuentes\" style=\"margin-top:32px;margin-bottom:12px\">Frequently asked questions<\/h2>\n<h3 style=\"margin-top:24px;margin-bottom:8px\">What is the difference between poor posture and flat back in adults?<\/h3>\n<p style=\"margin-bottom:16px;line-height:1.7\">Poor posture is usually flexible and changes with attention or rest. Flat back in adults implies a more structural loss of lordosis, with bodily compensations and often functional limitation.<\/p>\n<h3 style=\"margin-top:24px;margin-bottom:8px\">Does flat back always cause pain?<\/h3>\n<p style=\"margin-bottom:16px;line-height:1.7\">Not always. Some people notice more fatigue, stiffness or difficulty standing than intense pain. Others do have low back pain, hip pain or pain when walking.<\/p>\n<h3 style=\"margin-top:24px;margin-bottom:8px\">Can an MRI diagnose it by itself?<\/h3>\n<p style=\"margin-bottom:16px;line-height:1.7\">No. MRI helps visualize discs and nerves, but the functional diagnosis of flat back in adults requires standing radiographs, physical examination and assessment of global balance.<\/p>\n<h3 style=\"margin-top:24px;margin-bottom:8px\">Can exercise restore lost lordosis?<\/h3>\n<p style=\"margin-bottom:16px;line-height:1.7\">Exercise can improve mobility, postural control and symptoms, but it does not always correct a fixed deformity. Nonetheless, it is often an important part of conservative treatment.<\/p>\n<h3 style=\"margin-top:24px;margin-bottom:8px\">When is surgery considered?<\/h3>\n<p style=\"margin-bottom:16px;line-height:1.7\">Surgery is considered when the deformity causes persistent pain, inability to walk or stand, significant compensations or neurological problems, and when non-surgical treatment is insufficient.<\/p>\n<h3 style=\"margin-top:24px;margin-bottom:8px\">Can you have flat back without prior surgery?<\/h3>\n<p style=\"margin-bottom:16px;line-height:1.7\">Yes. Although prior surgery is a classic cause, it can also arise from degeneration, progressive stiffness, fractures or adult deformities.<\/p>\n<h3 style=\"margin-top:24px;margin-bottom:8px\">Why do I lean when I walk?<\/h3>\n<p style=\"margin-bottom:16px;line-height:1.7\">Because the body tries to keep the center of gravity over the feet. If lumbar lordosis is insufficient, the trunk may move forward to compensate for the imbalance.<\/p>\n<h3 style=\"margin-top:24px;margin-bottom:8px\">Can flat back worsen over time?<\/h3>\n<p style=\"margin-bottom:16px;line-height:1.7\">Yes, especially if the structural cause progresses or compensations become exhausted. That is why a progressively more forward gait or increasing postural fatigue should not be normalized.<\/p>\n<h2 id=\"glosario\" style=\"margin-top:32px;margin-bottom:12px\">Glossary of medical terms<\/h2>\n<ul style=\"margin-bottom:16px;line-height:1.7\">\n<li><strong>Lumbar lordosis:<\/strong> the normal inward curvature of the lower back.<\/li>\n<li><strong>Sagittal deformity:<\/strong> alteration of spinal alignment seen from the side.<\/li>\n<li><strong>Sagittal balance:<\/strong> the body&#8217;s ability to remain aligned over the pelvis and feet.<\/li>\n<li><strong>Standing (weight-bearing):<\/strong> upright position bearing the body&#8217;s weight.<\/li>\n<li><strong>Postural compensation:<\/strong> mechanism the body uses to maintain balance when one area is altered.<\/li>\n<li><strong>Lumbar fusion:<\/strong> surgery in which several vertebral segments are permanently joined.<\/li>\n<li><strong>Osteotomy:<\/strong> controlled bone cut to correct a deformity.<\/li>\n<li><strong>Pseudoarthrosis:<\/strong> lack of bony union after fusion surgery.<\/li>\n<li><strong>Sagittal vertical axis (SVA):<\/strong> radiographic measure of the spine&#8217;s global balance in the sagittal plane.<\/li>\n<li><strong>Pelvic retroversion:<\/strong> backward rotation of the pelvis to compensate for poor spinal alignment.<\/li>\n<\/ul>\n<h2 id=\"referencias\" style=\"margin-top:32px;margin-bottom:12px\">References<\/h2>\n<ul style=\"margin-bottom:16px;line-height:1.7\">\n<li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/36274246\/\" target=\"_blank\" rel=\"noopener\">PubMed, Adult Spinal Deformity: A Comprehensive Review of Current Advances and Future Directions, 2022<\/a><\/li>\n<li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/29738410\/\" target=\"_blank\" rel=\"noopener\">PubMed, Sagittal Spinal Alignment in Adult Spinal Deformity: An Overview of Current Concepts and a Critical Analysis Review, 2018<\/a><\/li>\n<li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/33254357\/\" target=\"_blank\" rel=\"noopener\">PubMed, Adult Spinal Deformity: Current Concepts and Decision-Making Strategies for Management, 2020<\/a><\/li>\n<li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/21102297\/\" target=\"_blank\" rel=\"noopener\">PubMed, Adult spinal deformity-postoperative standing imbalance: how much can you tolerate?, 2011<\/a><\/li>\n<li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/24095099\/\" target=\"_blank\" rel=\"noopener\">PubMed, Lumbar lordosis, 2014<\/a><\/li>\n<li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/37482640\/\" target=\"_blank\" rel=\"noopener\">PubMed, Changes in Spinopelvic Parameters Between Standing and Sitting Postures: A Systematic Review and Meta-analysis, 2023<\/a><\/li>\n<li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/38590852\/\" target=\"_blank\" rel=\"noopener\">PubMed, Sagittal balance in sitting and standing positions: A systematic review of radiographic measures, 2024<\/a><\/li>\n<li><a href=\"https:\/\/www.cochrane.org\/evidence\/CD009790_exercise-treatment-chronic-low-back-pain\" target=\"_blank\" rel=\"noopener\">Cochrane, Exercise for treatment of chronic low back pain, 2021<\/a><\/li>\n<li><a href=\"https:\/\/www.nice.org.uk\/guidance\/ng59\" target=\"_blank\" rel=\"noopener\">NICE, Low back pain and sciatica in over 16s: assessment and management, 2016<\/a><\/li>\n<li><a href=\"https:\/\/www.aans.org\/files\/aans_and_cns_position_statement_on_arthrodesis_of_the_spine_final-approved_082121-ashx-2?view=1\" target=\"_blank\" rel=\"noopener\">AANS\/CNS, Position Statement on Arthrodesis of the Spine, 2021<\/a><\/li>\n<li><a href=\"https:\/\/www.mayoclinic.org\/diseases-conditions\/back-pain\/symptoms-causes\/syc-20369906\" target=\"_blank\" rel=\"noopener\">Mayo Clinic, Back pain: Symptoms and causes, 2024<\/a><\/li>\n<li><a href=\"https:\/\/www.nice.org.uk\/guidance\/htg274\/chapter\/3-Clinical-need-and-practice\" target=\"_blank\" rel=\"noopener\">NICE, The EOS 2D\/3D imaging system: Clinical need and practice, 2011<\/a><\/li>\n<\/ul>\n<p style=\"margin-top:32px;padding:16px;background:#f4f6f8;border-left:4px solid #0B2545\"><strong>Notice: this content is for educational and informational purposes only and does not replace assessment, diagnosis or treatment by a qualified healthcare professional. If you have any symptoms, consult a physician. Flat back in adults requires individualized evaluation and, in some cases, imaging and specialist examination.<\/strong><\/p>\n<p style=\"margin-top:24px;line-height:1.7\">If symptoms persist or worsen, the safest option is to <a href=\"https:\/\/complexspineinstitute.com\/en\/request-evaluation\/\">request an evaluation<\/a> with a spine specialist, who can assess your specific case and advise on the most appropriate options.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Flat back in adults is not the same as \u201chaving poor posture.\u201d When lumbar lordosis \u2014the inward curve of the lower back\u2014 is significantly lost, the body no longer balances well over the pelvis and the person may begin to walk leaning forward, tire when standing and need to bend the knees or hips to [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":9057,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"rank_math_title":"Flat back in adults: signs and diagnosis","rank_math_description":"Learn to recognize flat back in adults, its symptoms, how it is diagnosed and when specialist assessment is required.","rank_math_focus_keyword":"flat back","footnotes":""},"categories":[19],"tags":[],"class_list":["post-9059","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-neurosurgery-blog"],"_links":{"self":[{"href":"https:\/\/complexspineinstitute.com\/en\/wp-json\/wp\/v2\/posts\/9059","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/complexspineinstitute.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/complexspineinstitute.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/complexspineinstitute.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/complexspineinstitute.com\/en\/wp-json\/wp\/v2\/comments?post=9059"}],"version-history":[{"count":1,"href":"https:\/\/complexspineinstitute.com\/en\/wp-json\/wp\/v2\/posts\/9059\/revisions"}],"predecessor-version":[{"id":9063,"href":"https:\/\/complexspineinstitute.com\/en\/wp-json\/wp\/v2\/posts\/9059\/revisions\/9063"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/complexspineinstitute.com\/en\/wp-json\/wp\/v2\/media\/9057"}],"wp:attachment":[{"href":"https:\/\/complexspineinstitute.com\/en\/wp-json\/wp\/v2\/media?parent=9059"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/complexspineinstitute.com\/en\/wp-json\/wp\/v2\/categories?post=9059"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/complexspineinstitute.com\/en\/wp-json\/wp\/v2\/tags?post=9059"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}