Non Harrington Rod Flatback Syndrome (Iatrogenically (Surgically-Induced Flatback)

March 17, 2011

There is an outstanding Flatback Syndrome article on Scoliosisnutty.com written by beth Mina. She divides Flatback Syndrome into two types: 1) Harrington Rod - Induced Flatback and 2) Iatrogenically (Surgically-Induced Flatback). I am quoting the differences of those two types below:

HARRINGTON ROD - INDUCED FLATBACK:

Occurs gradually over time, allowing the body to adapt gradually to many of the changes in lordosis until a critical point is reached where there are no more ways for the body to compensate for the steadily reducing curve at the backwaist.

Because of the gradual change in lordosis, symptoms may not be noticed for 10-20 years.

When at the 10-20 year point, patients realize they have become noticeably deformed, with obvious leaning-forward postures that prevent them from even raising their heads to look straight, making the condition easy for doctors to diagnose.

IATROGENICALLY (SURGICALLY-INDUCED) FLATBACK:

Occurs immediately on the operating table so that patients usually feel unbalanced right away while noticing that they also look different and discover they can't fit into previously-worn clothes--yet they are unable to determine exactly what is "wrong."

Since this form of Flatback occurs all at once, the body cannot adjust to the huge sudden change of lordosis reduction, and symptoms begin occurring in 1-3 years rather than 10-20.

Since most cases of Iatrogenically-Induced Flatback are caused in scoliosis patients who originally had hyperlordosis (see section below on Hyperlordosis in the Spinal Fusion Patient), their new backwaist curves are NOT flat, but are just reduced to an extent that their bodies cannot tolerate; therefore they do not present as particularly deformed. (Compensatory knee bending and neck craning, unconsciously performed by the patient, may indeed make such victims look nearly normal, even to the trained eye.)

Because these Flatback patients do not appear deformed to most doctors--even to scoliosis experts, who associate Flatback Syndrome with the "key" sign of completely flat backwaists--these patients often spend many devastating years going from doctor to doctor until they are able to obtain correct Flatback diagnoses; in the meantime, these patients are often identified mistakenly as psychiatric cases, leading to treatment with inappropriate medications and therapies, accompanied by intense frustration. (This is why scoliosis patients are advised to ALWAYS gather and retain their x-rays, because Iatrogenic Flatback can only be 100% confirmed by spinal surgeons who can compare patients' before and after x-rays to see their changed lordosis curvatures.) 5. Because patients with Iatrogenically-Induced Flatback cases do not appear as "deformed," there is a tendency on the part of doctors--even scoliosis experts--to advise against corrective surgery even though their physical symptoms, pain, and disabling aspects are just as severe as those Flatback patients who "look" worse; therefore, their access to appropriate osteotomies can be impeded.

My history is almost a mirror image of that second type. I had my surgeries in July 1996, and Sept. 1996 (second one due to loose hooks) at MetroHealth Medical Center in Cleveland, Ohio performed by Clyde L. Nash, M.D. I am fused from t9 to S1 using AcroMed Instrumentation (a generic version of Texas ish Rite Hospital (TSRH) Instrumentation System. I was living and working in the Washington, D.C. area at the time. During about two years prior to my surgeries and about two years following my surgeries I saw T. Stinson, M.D. at Shady Grove Adventist Hospital in Rockville, land. Dr. Stinson did his spine fellowship at St. Lukes Hospital in Cleveland, Ohio. Dr. Nash was the chief of the department at St. Lukes during that time. I started having pain issues very soon after I stopped wearing the post-surgery brace. Dr. Stinson did very little to help me with those issues; however, he always asked me when I would be seeing Dr. Nash. I therefore started seeing C. Lauerman, M.D. at town University Hospital in Washington, D.C. Dr. Lauerman couldn't find a reason for my pain; however, he referred me to a Physiatrist (Physical Medicine and Rehabilitation Physician). That doctor put me on a number of non-narcotic medications. He also referred me to physical therapy and acupuncture/acupressure treatments. None of these treatments relieved my pain. The Physiatrist referred me to a Psychiatrist who specialized in pain management. He put me on Vicoprofen and Fentanyl Patches. This did relieve my pain fairly well for a number of years; however, I often needed a higher and higher strength of the Fentanyl for the same relief. Over time, the side effects to the Fentanyl became significant (extreme nausea and my weight went down to 95 lbs.). Sitting (doing most tasks), standing, and driving also became very painful. An added issue was I began having tingling in my hand often when resting. The PCP I was seeing referred me to a neurologist in early-mid 2007. Initially, he thought I had carpal tunnel syndrome. He referred me for physical therapy; however, it didn't help. He had me get a cervical spine MRI. It showed mild to moderate DDD and disc bulges or disc herniations at all levels exept at the C6-C7 levels. The most severe was at the C3-4 level where there was a grade 1 anterolisthesis and a moderate to large size central and right paracentral disc herniation compressing my spinal cord.The neurologist then had me get an MRI on the remaining part. of my spine which only showed some minor issues. He then referred me to an orthopedic surgeon I had not seen before for a consult. He was the first to mention Flatback Syndrome (when I had an appointment with Dr. Nash in early 2008 he said that I had in since my surgeries (I had known that I had spinal arthritis at the time of my surgeries). I went began going into work less and less, until I totally stopped working, and have been on Social Security Disability and Federal Employee Disability Retirement since 2007. I moved back to Cleveland, Ohio from Washington, D.C. in late 2008. I entered the Cleveland Clinic's Outpatient Chronic Pain Rehabilitation Program (CPRP) during May 2009. I was in the CPRP for about five weeks, and thankfully now off all narcotics. I ended up selling my car as driving made the pain overwhelming. As long as I "adjust" the way I do thing my pain is fairly well controlled. This includes leaning on something when standing. With my 15 year old dog that died back on Sept. 14th I would often lean on the patio door (or door frame) and let her out using an expandable leash. During the last year of her life that became difficult as the patio of my current apartment is enclosed. There were complaints from neighbors when I let her out on the patio. I got a Cockapoo puppy in November, and this past winter has been extremely difficult. Trying to remain standing when going in and outside in the Cleveland winter weather has resulted in major back, neck, and leg pain. Hills (even the slightest incline or dip) increased the pain significantly. I have also had swollen knees. The puppy "pulling" on the leash doesn't help any. Yaktrax Cleats were mentioned on this list, and I tried them. They however made things much much worse as I have to go over tile floors going outside (I nearly slipped no less than four times). I've been spending a great deal of time laying on my bed due to the pain, and thinking my best chance for "relief" would be to make a move to an apartment with an open patio as I had in the past (at this time, the puppy has been having a lot of "accidents" in the apartment). I have an appointment in early April in the Cleveland clinic's Center for Spine Health. This doctor is non-surgery (at the Cleveland Clinic you have to be referred to a surgeon should that be needed). Dr. Nash is now retired from doing surgeries; however, still sees patients on a limited basis in the MetroHealth Medical Center's Orthopedic Clinic (depending on what the doctor at the Cleveland Clinic says I may try to schedule an appointment with Dr. Nash).

I was wondering if there are many others on the list with the Non Harrington Rod Flatback Syndrome (Iatrogenically (Surgically-Induced Flatback), and what their history and symptoms may be.

March 17, 2011

Dear - You may have heard my story before, so sorry if this is a repeat. I had surgically induced flatback syndrome. I initially had a Harrington rod surgery in 1979. It had to be removed a year later because it broke. I led a full & active life for the next 20 some odd years. In 2005 I was diagnosed with lumbar DDD. It also caused a slight thoracic kyphosis. In July of 2007 my surgeon convinced me to get the full length hardware of 2 rods & 18 screws with 2 discectomies & cages. This was supposed to prevent future & further deterioration & to insure quality of life. Immediately upon release from the hospital I noticed I was about an inch pitched forward. I really didn't care at that point. I figured an inch off center was the least of my problems. Within 3

months I had a forward pitch of 20 degrees. The stronger I got recovering from surgery, the worse my pain became & the further forward pitched I became. My surgeon kept telling me there was nothing wrong. It was just my body getting accustomed to the hardware. Within 16 months after surgery, I was ordered to stop work immediately & filed for SSDI. I also read the Mina article in December 2009 & it confirmed what I already had self diagnosed. My hardware was not installed correctly. The rods were too straight & had over corrected my natural lordosis to the point my body couldn't compensate. In the same month I found this group site & started my search for information & a surgeon who could help me. My revisions were December 14, 2010 & January 24, 2011 with Dr Hu at UCSF. She cut my rods in half & replace the bottom sections with more curved rods.

My before & after pics are in the photos section. This is my abbreviated story. A LOT of different physical deterioration happened in between. I tried many different techniques to try & stop it from progressing. I will be happy to compare more detailed notes if you want to E-mail me direct. I've noticed that there are a lot more members who had their flatback symptoms spread out over the years. Mine happened immediately & extreme. It was like a tornado that destoyed my life. I just thank God that there are surgeons out there who can correct what had been done to me. I'm hoping to be able to return to work within the next 8 months. Each day I get a little bit of what I lost back..............Kathy

From: RSSSCOLIOSIS@... <RSSSCOLIOSIS@...>Subject: [ ] Non Harrington Rod Flatback Syndrome (Iatrogenically (Surgically-Induced Flatback) , Date: Thursday, March 17, 2011, 4:50 PM

There is an outstanding Flatback Syndrome article on Scoliosisnutty.com written by beth Mina. She divides Flatback Syndrome into two types: 1) Harrington Rod - Induced Flatback and 2) Iatrogenically (Surgically-Induced Flatback). I am quoting the differences of those two types below:HARRINGTON ROD - INDUCED FLATBACK:Occurs gradually over time, allowing the body to adapt gradually to many of the changes in lordosis until a critical point is reached where there are no more ways for the body to compensate for the steadily reducing curve at the backwaist.Because of the gradual change in lordosis, symptoms may not be noticed for 10-20 years.When at the 10-20 year point, patients realize they have become noticeably deformed, with obvious leaning-forward postures that prevent them from even raising their heads to look straight, making the condition easy for doctors to diagnose.IATROGENICALLY

(SURGICALLY-INDUCED) FLATBACK:Occurs immediately on the operating table so that patients usually feel unbalanced right away while noticing that they also look different and discover they can't fit into previously-worn clothes--yet they are unable to determine exactly what is "wrong."Since this form of Flatback occurs all at once, the body cannot adjust to the huge sudden change of lordosis reduction, and symptoms begin occurring in 1-3 years rather than 10-20.Since most cases of Iatrogenically-Induced Flatback are caused in scoliosis patients who originally had hyperlordosis (see section below on Hyperlordosis in the Spinal Fusion Patient), their new backwaist curves are NOT flat, but are just reduced to an extent that their bodies cannot tolerate; therefore they do not present as particularly deformed. (Compensatory knee bending and neck craning, unconsciously performed by the patient, may indeed make such victims look nearly normal,

even to the trained eye.)Because these Flatback patients do not appear deformed to most doctors--even to scoliosis experts, who associate Flatback Syndrome with the "key" sign of completely flat backwaists--these patients often spend many devastating years going from doctor to doctor until they are able to obtain correct Flatback diagnoses; in the meantime, these patients are often identified mistakenly as psychiatric cases, leading to treatment with inappropriate medications and therapies, accompanied by intense frustration. (This is why scoliosis patients are advised to ALWAYS gather and retain their x-rays, because Iatrogenic Flatback can only be 100% confirmed by spinal surgeons who can compare patients' before and after x-rays to see their changed lordosis curvatures.) 5. Because patients with Iatrogenically-Induced Flatback cases do not appear as "deformed," there is a tendency on the part of doctors--even scoliosis experts--to advise against

corrective surgery even though their physical symptoms, pain, and disabling aspects are just as severe as those Flatback patients who "look" worse; therefore, their access to appropriate osteotomies can be impeded.My history is almost a mirror image of that second type. I had my surgeries in July 1996, and Sept. 1996 (second one due to loose hooks) at MetroHealth Medical Center in Cleveland, Ohio performed by Clyde L. Nash, M.D. I am fused from t9 to S1 using AcroMed Instrumentation (a generic version of Texas ish Rite Hospital (TSRH) Instrumentation System. I was living and working in the Washington, D.C. area at the time. During about two years prior to my surgeries and about two years following my surgeries I saw T. Stinson, M.D. at Shady Grove Adventist Hospital in Rockville, land. Dr. Stinson did his spine fellowship at St. Lukes Hospital in Cleveland, Ohio. Dr. Nash was the chief of the department at St.

Lukes during that time. I started having pain issues very soon after I stopped wearing the post-surgery brace. Dr. Stinson did very little to help me with those issues; however, he always asked me when I would be seeing Dr. Nash. I therefore started seeing C. Lauerman, M.D. at town University Hospital in Washington, D.C. Dr. Lauerman couldn't find a reason for my pain; however, he referred me to a Physiatrist (Physical Medicine and Rehabilitation Physician). That doctor put me on a number of non-narcotic medications. He also referred me to physical therapy and acupuncture/acupressure treatments. None of these treatments relieved my pain. The Physiatrist referred me to a Psychiatrist who specialized in pain management. He put me on Vicoprofen and Fentanyl Patches. This did relieve my pain fairly well for a number of years; however, I often needed a higher and higher strength of the Fentanyl for the same relief. Over time, the side effects to the Fentanyl became significant (extreme nausea and my weight went down to 95 lbs.). Sitting (doing most tasks), standing, and driving also became very painful. An added issue was I began having tingling in my hand often when resting. The PCP I was seeing referred me to a neurologist in early-mid 2007. Initially, he thought I had carpal tunnel syndrome. He referred me for physical therapy; however, it didn't help. He had me get a cervical spine MRI. It showed mild to moderate DDD and disc bulges or disc herniations at all levels exept at the C6-C7 levels. The most severe was at the C3-4 level where there was a grade 1 anterolisthesis and a moderate to large size central and right paracentral disc herniation compressing my spinal cord.The neurologist then had me get an MRI on the remaining part. of my spine which only showed some minor issues. He then referred me to an orthopedic surgeon I had not seen before for a consult. He was the first to mention Flatback Syndrome (when I had an appointment with Dr. Nash in early 2008 he

said that I had in since my surgeries (I had known that I had spinal arthritis at the time of my surgeries). I went began going into work less and less, until I totally stopped working, and have been on Social Security Disability and Federal Employee Disability Retirement since 2007. I moved back to Cleveland, Ohio from Washington, D.C. in late 2008. I entered the Cleveland Clinic's Outpatient Chronic Pain Rehabilitation Program (CPRP) during May 2009. I was in the CPRP for about five weeks, and thankfully now off all narcotics. I ended up selling my car as driving made the pain overwhelming. As long as I "adjust" the way I do thing my pain is fairly well controlled. This includes leaning on something when standing. With my 15 year old dog that died back on Sept. 14th I would often lean on the patio door (or door frame) and let her out using an

expandable leash. During the last year of her life that became difficult as the patio of my current apartment is enclosed. There were complaints from neighbors when I let her out on the patio. I got a Cockapoo puppy in November, and this past winter has been extremely difficult. Trying to remain standing when going in and outside in the Cleveland winter weather has resulted in major back, neck, and leg pain. Hills (even the slightest incline or dip) increased the pain significantly. I have also had swollen knees. The puppy "pulling" on the leash doesn't help any. Yaktrax Cleats were mentioned on this list, and I tried them. They however made things much much worse as I have to go over tile floors going outside (I nearly slipped no less than four times). I've been spending a great deal of time laying on my bed due to the pain, and thinking my best chance for "relief" would be to make a move to an apartment with an open patio as I had in

the past (at this time, the puppy has been having a lot of "accidents" in the apartment). I have an appointment in early April in the Cleveland clinic's Center for Spine Health. This doctor is non-surgery (at the Cleveland Clinic you have to be referred to a surgeon should that be needed). Dr. Nash is now retired from doing surgeries; however, still sees patients on a limited basis in the MetroHealth Medical Center's Orthopedic Clinic (depending on what the doctor at the Cleveland Clinic says I may try to schedule an appointment with Dr. Nash).I was wondering if there are many others on the list with the Non Harrington Rod Flatback Syndrome (Iatrogenically (Surgically-Induced Flatback), and what their history and symptoms may be.

March 19, 2011

I find these terms to be interesting. I don't have Harrington rods. Mine are

Luque instrumentation (original fusion in 1989). But my flatback didn't seem to

be instantaneous. Yet my flatback revision surgeon described my flatback as

iatrogenic flatback.

It makes me wonder how universal these terms actually are? Perhaps my flatback

WAS created immediately during my surgery (though I specifically remember talks

about the need to retain lordosis, and how bad it was earlier because docs

didn't originally do this - this was from my original pediatric surgeon in

1989!), but I didn't feel off-balance right away. I think that I developed

flatback at a faster rate than many Harrington people do - since most of them

seem to be in their 40s, 50s and even 60s when they find these lists, and I was

just 31 when I had my revision. But like I said before, these terms to describe

Harrington versus iatrogenic flatback are quite interesting.

Thanks for sharing the article! Any clue as to when Mina wrote the

article?

>

> There is an outstanding Flatback Syndrome article on Scoliosisnutty.com

written by beth Mina. She divides Flatback Syndrome into two types: 1)

Harrington Rod - Induced Flatback and 2) Iatrogenically (Surgically-Induced

Flatback). I am quoting the differences of those two types below:

>

> HARRINGTON ROD - INDUCED FLATBACK:

>

> Occurs gradually over time, allowing the body to adapt gradually to many of

the changes in lordosis until a critical point is reached where there are no

more ways for the body to compensate for the steadily reducing curve at the

backwaist.

> Because of the gradual change in lordosis, symptoms may not be noticed for

10-20 years.

> When at the 10-20 year point, patients realize they have become noticeably

deformed, with obvious leaning-forward postures that prevent them from even

raising their heads to look straight, making the condition easy for doctors to

diagnose.

>

> IATROGENICALLY (SURGICALLY-INDUCED) FLATBACK:

>

> Occurs immediately on the operating table so that patients usually feel

unbalanced right away while noticing that they also look different and discover

they can't fit into previously-worn clothes--yet they are unable to determine

exactly what is " wrong. "

> Since this form of Flatback occurs all at once, the body cannot adjust to the

huge sudden change of lordosis reduction, and symptoms begin occurring in 1-3

years rather than 10-20.

> Since most cases of Iatrogenically-Induced Flatback are caused in scoliosis

patients who originally had hyperlordosis (see section below on Hyperlordosis in

the Spinal Fusion Patient), their new backwaist curves are NOT flat, but are

just reduced to an extent that their bodies cannot tolerate; therefore they do

not present as particularly deformed. (Compensatory knee bending and neck

craning, unconsciously performed by the patient, may indeed make such victims

look nearly normal, even to the trained eye.)

> Because these Flatback patients do not appear deformed to most doctors--even

to scoliosis experts, who associate Flatback Syndrome with the " key " sign of

completely flat backwaists--these patients often spend many devastating years

going from doctor to doctor until they are able to obtain correct Flatback

diagnoses; in the meantime, these patients are often identified mistakenly as

psychiatric cases, leading to treatment with inappropriate medications and

therapies, accompanied by intense frustration. (This is why scoliosis patients

are advised to ALWAYS gather and retain their x-rays, because Iatrogenic

Flatback can only be 100% confirmed by spinal surgeons who can compare patients'

before and after x-rays to see their changed lordosis curvatures.) 5. Because

patients with Iatrogenically-Induced Flatback cases do not appear as " deformed, "

there is a tendency on the part of doctors--even scoliosis experts--to advise

against corrective surgery even though their physical symptoms, pain, and

disabling aspects are just as severe as those Flatback patients who " look "

worse; therefore, their access to appropriate osteotomies can be impeded.

>

> My history is almost a mirror image of that second type. I had my surgeries in

July 1996, and Sept. 1996 (second one due to loose hooks) at MetroHealth Medical

Center in Cleveland, Ohio performed by Clyde L. Nash, M.D. I am fused from t9 to

S1 using AcroMed Instrumentation (a generic version of Texas ish Rite

Hospital (TSRH) Instrumentation System. I was living and working in the

Washington, D.C. area at the time. During about two years prior to my surgeries

and about two years following my surgeries I saw T. Stinson, M.D. at Shady

Grove Adventist Hospital in Rockville, land. Dr. Stinson did his spine

fellowship at St. Lukes Hospital in Cleveland, Ohio. Dr. Nash was the chief of

the department at St. Lukes during that time. I started having pain issues very

soon after I stopped wearing the post-surgery brace. Dr. Stinson did very little

to help me with those issues; however, he always asked me when I would be seeing

Dr. Nash. I therefore started seeing C. Lauerman, M.D. at town

University Hospital in Washington, D.C. Dr. Lauerman couldn't find a reason for

my pain; however, he referred me to a Physiatrist (Physical Medicine and

Rehabilitation Physician). That doctor put me on a number of non-narcotic

medications. He also referred me to physical therapy and acupuncture/acupressure

treatments. None of these treatments relieved my pain. The Physiatrist referred

me to a Psychiatrist who specialized in pain management. He put me on Vicoprofen

and Fentanyl Patches. This did relieve my pain fairly well for a number of

years; however, I often needed a higher and higher strength of the Fentanyl for

the same relief. Over time, the side effects to the Fentanyl became significant

(extreme nausea and my weight went down to 95 lbs.). Sitting (doing most tasks),

standing, and driving also became very painful. An added issue was I began

having tingling in my hand often when resting. The PCP I was seeing referred me

to a neurologist in early-mid 2007. Initially, he thought I had carpal tunnel

syndrome. He referred me for physical therapy; however, it didn't help. He had

me get a cervical spine MRI. It showed mild to moderate DDD and disc bulges or

disc herniations at all levels exept at the C6-C7 levels. The most severe was at

the C3-4 level where there was a grade 1 anterolisthesis and a moderate to large

size central and right paracentral disc herniation compressing my spinal

cord.The neurologist then had me get an MRI on the remaining part. of my spine

which only showed some minor issues. He then referred me to an orthopedic

surgeon I had not seen before for a consult. He was the first to mention

Flatback Syndrome (when I had an appointment with Dr. Nash in early 2008 he said

that I had in since my surgeries (I had known that I had spinal arthritis at the

time of my surgeries). I went began going into work less and less, until I

totally stopped working, and have been on Social Security Disability and Federal

Employee Disability Retirement since 2007. I moved back to Cleveland, Ohio from

Washington, D.C. in late 2008. I entered the Cleveland Clinic's Outpatient

Chronic Pain Rehabilitation Program (CPRP) during May 2009. I was in the CPRP

for about five weeks, and thankfully now off all narcotics. I ended up selling

my car as driving made the pain overwhelming. As long as I " adjust " the way I do

thing my pain is fairly well controlled. This includes leaning on something when

standing. With my 15 year old dog that died back on Sept. 14th I would often

lean on the patio door (or door frame) and let her out using an expandable

leash. During the last year of her life that became difficult as the patio of my

current apartment is enclosed. There were complaints from neighbors when I let

her out on the patio. I got a Cockapoo puppy in November, and this past winter

has been extremely difficult. Trying to remain standing when going in and

outside in the Cleveland winter weather has resulted in major back, neck, and

leg pain. Hills (even the slightest incline or dip) increased the pain

significantly. I have also had swollen knees. The puppy " pulling " on the leash

doesn't help any. Yaktrax Cleats were mentioned on this list, and I tried them.

They however made things much much worse as I have to go over tile floors going

outside (I nearly slipped no less than four times). I've been spending a great

deal of time laying on my bed due to the pain, and thinking my best chance for

" relief " would be to make a move to an apartment with an open patio as I had in

the past (at this time, the puppy has been having a lot of " accidents " in the

apartment). I have an appointment in early April in the Cleveland clinic's

Center for Spine Health. This doctor is non-surgery (at the Cleveland Clinic you

have to be referred to a surgeon should that be needed). Dr. Nash is now retired

from doing surgeries; however, still sees patients on a limited basis in the

MetroHealth Medical Center's Orthopedic Clinic (depending on what the doctor at

the Cleveland Clinic says I may try to schedule an appointment with Dr. Nash).

>

> I was wondering if there are many others on the list with the Non Harrington

Rod Flatback Syndrome (Iatrogenically (Surgically-Induced Flatback), and what

their history and symptoms may be.

>

March 19, 2011

Hi = I read the article well over a year ago. I think it's been around for quite some time. I happen to be one of the surgical induced faltback people. I had perfect sagittal balance prior to my surgery in 2007. Immediately after surgery I noticed I was about an inch tipped forward. I progressed to 25 degrees within 3 months...and a full 40 degrees within a year. Harrington rod induced is a generic term used because so many Harrington patients developed it over the years. It is the same for Luque and other hardware patients too. It's how they describe the difference of it developing over years or all at once. Mina wrote this back when hardly anyone even heard of Flatback. So some of it may sound a little dated, but for the most part it still holds up today. on

this forum knows much nore about the article. I think she even mentioned once that she had met Mina................................Kathy

From: rebeccamaas <rebeccamaas@...>Subject: Re: Non Harrington Rod Flatback Syndrome (Iatrogenically (Surgically-Induced Flatback) Date: Saturday, March 19, 2011, 7:14 PM

I find these terms to be interesting. I don't have Harrington rods. Mine are Luque instrumentation (original fusion in 1989). But my flatback didn't seem to be instantaneous. Yet my flatback revision surgeon described my flatback as iatrogenic flatback.It makes me wonder how universal these terms actually are? Perhaps my flatback WAS created immediately during my surgery (though I specifically remember talks about the need to retain lordosis, and how bad it was earlier because docs didn't originally do this - this was from my original pediatric surgeon in 1989!), but I didn't feel off-balance right away. I think that I developed flatback at a faster rate than many Harrington people do - since most of them seem to be in their 40s, 50s and even 60s when they find these lists, and I was just 31 when I had my revision. But like I said before, these terms to describe Harrington versus iatrogenic flatback are quite interesting.Thanks for

sharing the article! Any clue as to when Mina wrote the article?>> > > > > > There is an outstanding Flatback Syndrome article on Scoliosisnutty.com written by beth Mina. She divides Flatback Syndrome into two types: 1) Harrington Rod - Induced Flatback and 2) Iatrogenically (Surgically-Induced Flatback). I am quoting the differences of those two types below:> > HARRINGTON ROD - INDUCED FLATBACK:> > Occurs gradually over time, allowing the body to adapt gradually to many of the changes in lordosis until a critical point is reached where there are no more ways for the body to compensate

for the steadily reducing curve at the backwaist.> Because of the gradual change in lordosis, symptoms may not be noticed for 10-20 years.> When at the 10-20 year point, patients realize they have become noticeably deformed, with obvious leaning-forward postures that prevent them from even raising their heads to look straight, making the condition easy for doctors to diagnose.> > IATROGENICALLY (SURGICALLY-INDUCED) FLATBACK:> > Occurs immediately on the operating table so that patients usually feel unbalanced right away while noticing that they also look different and discover they can't fit into previously-worn clothes--yet they are unable to determine exactly what is "wrong."> Since this form of Flatback occurs all at once, the body cannot adjust to the huge sudden change of lordosis reduction, and symptoms begin occurring in 1-3 years rather than 10-20.> Since most cases of

Iatrogenically-Induced Flatback are caused in scoliosis patients who originally had hyperlordosis (see section below on Hyperlordosis in the Spinal Fusion Patient), their new backwaist curves are NOT flat, but are just reduced to an extent that their bodies cannot tolerate; therefore they do not present as particularly deformed. (Compensatory knee bending and neck craning, unconsciously performed by the patient, may indeed make such victims look nearly normal, even to the trained eye.)> Because these Flatback patients do not appear deformed to most doctors--even to scoliosis experts, who associate Flatback Syndrome with the "key" sign of completely flat backwaists--these patients often spend many devastating years going from doctor to doctor until they are able to obtain correct Flatback diagnoses; in the meantime, these patients are often identified mistakenly as psychiatric cases, leading to treatment with inappropriate medications and

therapies, accompanied by intense frustration. (This is why scoliosis patients are advised to ALWAYS gather and retain their x-rays, because Iatrogenic Flatback can only be 100% confirmed by spinal surgeons who can compare patients' before and after x-rays to see their changed lordosis curvatures.) 5. Because patients with Iatrogenically-Induced Flatback cases do not appear as "deformed," there is a tendency on the part of doctors--even scoliosis experts--to advise against corrective surgery even though their physical symptoms, pain, and disabling aspects are just as severe as those Flatback patients who "look" worse; therefore, their access to appropriate osteotomies can be impeded.> > My history is almost a mirror image of that second type. I had my surgeries in July 1996, and Sept. 1996 (second one due to loose hooks) at MetroHealth Medical Center in Cleveland, Ohio performed by Clyde L. Nash, M.D. I am fused from t9 to S1 using AcroMed

Instrumentation (a generic version of Texas ish Rite Hospital (TSRH) Instrumentation System. I was living and working in the Washington, D.C. area at the time. During about two years prior to my surgeries and about two years following my surgeries I saw T. Stinson, M.D. at Shady Grove Adventist Hospital in Rockville, land. Dr. Stinson did his spine fellowship at St. Lukes Hospital in Cleveland, Ohio. Dr. Nash was the chief of the department at St. Lukes during that time. I started having pain issues very soon after I stopped wearing the post-surgery brace. Dr. Stinson did very little to help me with those issues; however, he always asked me when I would be seeing Dr. Nash. I therefore started seeing C. Lauerman, M.D. at town University Hospital in Washington, D.C. Dr. Lauerman couldn't find a reason for my pain; however, he referred me to a Physiatrist (Physical Medicine and Rehabilitation Physician). That doctor put me on a

number of non-narcotic medications. He also referred me to physical therapy and acupuncture/acupressure treatments. None of these treatments relieved my pain. The Physiatrist referred me to a Psychiatrist who specialized in pain management. He put me on Vicoprofen and Fentanyl Patches. This did relieve my pain fairly well for a number of years; however, I often needed a higher and higher strength of the Fentanyl for the same relief. Over time, the side effects to the Fentanyl became significant (extreme nausea and my weight went down to 95 lbs.). Sitting (doing most tasks), standing, and driving also became very painful. An added issue was I began having tingling in my hand often when resting. The PCP I was seeing referred me to a neurologist in early-mid 2007. Initially, he thought I had carpal tunnel syndrome. He referred me for physical therapy; however, it didn't help. He had me get a cervical spine MRI. It showed mild to moderate DDD and disc

bulges or disc herniations at all levels exept at the C6-C7 levels. The most severe was at the C3-4 level where there was a grade 1 anterolisthesis and a moderate to large size central and right paracentral disc herniation compressing my spinal cord.The neurologist then had me get an MRI on the remaining part. of my spine which only showed some minor issues. He then referred me to an orthopedic surgeon I had not seen before for a consult. He was the first to mention Flatback Syndrome (when I had an appointment with Dr. Nash in early 2008 he said that I had in since my surgeries (I had known that I had spinal arthritis at the time of my surgeries). I went began going into work less and less, until I totally stopped working, and have been on Social Security Disability and Federal Employee Disability Retirement since 2007. I moved back to Cleveland, Ohio from Washington, D.C. in late 2008. I entered the Cleveland Clinic's Outpatient Chronic Pain

Rehabilitation Program (CPRP) during May 2009. I was in the CPRP for about five weeks, and thankfully now off all narcotics. I ended up selling my car as driving made the pain overwhelming. As long as I "adjust" the way I do thing my pain is fairly well controlled. This includes leaning on something when standing. With my 15 year old dog that died back on Sept. 14th I would often lean on the patio door (or door frame) and let her out using an expandable leash. During the last year of her life that became difficult as the patio of my current apartment is enclosed. There were complaints from neighbors when I let her out on the patio. I got a Cockapoo puppy in November, and this past winter has been extremely difficult. Trying to remain standing when going in and outside in the Cleveland winter weather has resulted in major back, neck, and leg pain. Hills (even the slightest incline or dip) increased the pain significantly. I have also had swollen knees.

The puppy "pulling" on the leash doesn't help any. Yaktrax Cleats were mentioned on this list, and I tried them. They however made things much much worse as I have to go over tile floors going outside (I nearly slipped no less than four times). I've been spending a great deal of time laying on my bed due to the pain, and thinking my best chance for "relief" would be to make a move to an apartment with an open patio as I had in the past (at this time, the puppy has been having a lot of "accidents" in the apartment). I have an appointment in early April in the Cleveland clinic's Center for Spine Health. This doctor is non-surgery (at the Cleveland Clinic you have to be referred to a surgeon should that be needed). Dr. Nash is now retired from doing surgeries; however, still sees patients on a limited basis in the MetroHealth Medical Center's Orthopedic Clinic (depending on what the doctor at the Cleveland Clinic says I may try to schedule an appointment

with Dr. Nash).> > I was wondering if there are many others on the list with the Non Harrington Rod Flatback Syndrome (Iatrogenically (Surgically-Induced Flatback), and what their history and symptoms may be.>

March 20, 2011

i cannot find the site that this Mina report is in I would like to know more I had Harrington Rod surgery in 1966 and do not have flatback or any pain whatsoever

From: rebeccamaas <rebeccamaas@...> Sent: Sat, March 19, 2011 10:14:21 PMSubject: Re: Non Harrington Rod Flatback Syndrome (Iatrogenically (Surgically-Induced Flatback)

I find these terms to be interesting. I don't have Harrington rods. Mine are Luque instrumentation (original fusion in 1989). But my flatback didn't seem to be instantaneous. Yet my flatback revision surgeon described my flatback as iatrogenic flatback.It makes me wonder how universal these terms actually are? Perhaps my flatback WAS created immediately during my surgery (though I specifically remember talks about the need to retain lordosis, and how bad it was earlier because docs didn't originally do this - this was from my original pediatric surgeon in 1989!), but I didn't feel off-balance right away. I think that I developed flatback at a faster rate than many Harrington people do - since most of them seem to be in their 40s, 50s and even 60s when they find these lists, and I was just 31 when I had my revision. But like I said before, these terms to describe Harrington versus iatrogenic flatback are quite interesting.Thanks for

sharing the article! Any clue as to when Mina wrote the article?>> > > > > > There is an outstanding Flatback Syndrome article on Scoliosisnutty.com written by beth Mina. She divides Flatback Syndrome into two types: 1) Harrington Rod - Induced Flatback and 2) Iatrogenically (Surgically-Induced Flatback). I am quoting the differences of those two types below:> > HARRINGTON ROD - INDUCED FLATBACK:> > Occurs gradually over time, allowing the body to adapt gradually to many of the changes in lordosis until a critical point is reached where there are no more ways for the body to compensate for the steadily reducing curve at the

backwaist.> Because of the gradual change in lordosis, symptoms may not be noticed for 10-20 years.> When at the 10-20 year point, patients realize they have become noticeably deformed, with obvious leaning-forward postures that prevent them from even raising their heads to look straight, making the condition easy for doctors to diagnose.> > IATROGENICALLY (SURGICALLY-INDUCED) FLATBACK:> > Occurs immediately on the operating table so that patients usually feel unbalanced right away while noticing that they also look different and discover they can't fit into previously-worn clothes--yet they are unable to determine exactly what is "wrong."> Since this form of Flatback occurs all at once, the body cannot adjust to the huge sudden change of lordosis reduction, and symptoms begin occurring in 1-3 years rather than 10-20.> Since most cases of Iatrogenically-Induced Flatback are caused in scoliosis

patients who originally had hyperlordosis (see section below on Hyperlordosis in the Spinal Fusion Patient), their new backwaist curves are NOT flat, but are just reduced to an extent that their bodies cannot tolerate; therefore they do not present as particularly deformed. (Compensatory knee bending and neck craning, unconsciously performed by the patient, may indeed make such victims look nearly normal, even to the trained eye.)> Because these Flatback patients do not appear deformed to most doctors--even to scoliosis experts, who associate Flatback Syndrome with the "key" sign of completely flat backwaists--these patients often spend many devastating years going from doctor to doctor until they are able to obtain correct Flatback diagnoses; in the meantime, these patients are often identified mistakenly as psychiatric cases, leading to treatment with inappropriate medications and therapies, accompanied by intense frustration. (This is why

scoliosis patients are advised to ALWAYS gather and retain their x-rays, because Iatrogenic Flatback can only be 100% confirmed by spinal surgeons who can compare patients' before and after x-rays to see their changed lordosis curvatures.) 5. Because patients with Iatrogenically-Induced Flatback cases do not appear as "deformed," there is a tendency on the part of doctors--even scoliosis experts--to advise against corrective surgery even though their physical symptoms, pain, and disabling aspects are just as severe as those Flatback patients who "look" worse; therefore, their access to appropriate osteotomies can be impeded.> > My history is almost a mirror image of that second type. I had my surgeries in July 1996, and Sept. 1996 (second one due to loose hooks) at MetroHealth Medical Center in Cleveland, Ohio performed by Clyde L. Nash, M.D. I am fused from t9 to S1 using AcroMed Instrumentation (a generic version of Texas ish Rite

Hospital (TSRH) Instrumentation System. I was living and working in the Washington, D.C. area at the time. During about two years prior to my surgeries and about two years following my surgeries I saw T. Stinson, M.D. at Shady Grove Adventist Hospital in Rockville, land. Dr. Stinson did his spine fellowship at St. Lukes Hospital in Cleveland, Ohio. Dr. Nash was the chief of the department at St. Lukes during that time. I started having pain issues very soon after I stopped wearing the post-surgery brace. Dr. Stinson did very little to help me with those issues; however, he always asked me when I would be seeing Dr. Nash. I therefore started seeing C. Lauerman, M.D. at town University Hospital in Washington, D.C. Dr. Lauerman couldn't find a reason for my pain; however, he referred me to a Physiatrist (Physical Medicine and Rehabilitation Physician). That doctor put me on a number of non-narcotic medications. He also referred me to

physical therapy and acupuncture/acupressure treatments. None of these treatments relieved my pain. The Physiatrist referred me to a Psychiatrist who specialized in pain management. He put me on Vicoprofen and Fentanyl Patches. This did relieve my pain fairly well for a number of years; however, I often needed a higher and higher strength of the Fentanyl for the same relief. Over time, the side effects to the Fentanyl became significant (extreme nausea and my weight went down to 95 lbs.). Sitting (doing most tasks), standing, and driving also became very painful. An added issue was I began having tingling in my hand often when resting. The PCP I was seeing referred me to a neurologist in early-mid 2007. Initially, he thought I had carpal tunnel syndrome. He referred me for physical therapy; however, it didn't help. He had me get a cervical spine MRI. It showed mild to moderate DDD and disc bulges or disc herniations at all levels exept at the C6-C7

levels. The most severe was at the C3-4 level where there was a grade 1 anterolisthesis and a moderate to large size central and right paracentral disc herniation compressing my spinal cord.The neurologist then had me get an MRI on the remaining part. of my spine which only showed some minor issues. He then referred me to an orthopedic surgeon I had not seen before for a consult. He was the first to mention Flatback Syndrome (when I had an appointment with Dr. Nash in early 2008 he said that I had in since my surgeries (I had known that I had spinal arthritis at the time of my surgeries). I went began going into work less and less, until I totally stopped working, and have been on Social Security Disability and Federal Employee Disability Retirement since 2007. I moved back to Cleveland, Ohio from Washington, D.C. in late 2008. I entered the Cleveland Clinic's Outpatient Chronic Pain Rehabilitation Program (CPRP) during May 2009. I was in the CPRP for

about five weeks, and thankfully now off all narcotics. I ended up selling my car as driving made the pain overwhelming. As long as I "adjust" the way I do thing my pain is fairly well controlled. This includes leaning on something when standing. With my 15 year old dog that died back on Sept. 14th I would often lean on the patio door (or door frame) and let her out using an expandable leash. During the last year of her life that became difficult as the patio of my current apartment is enclosed. There were complaints from neighbors when I let her out on the patio. I got a Cockapoo puppy in November, and this past winter has been extremely difficult. Trying to remain standing when going in and outside in the Cleveland winter weather has resulted in major back, neck, and leg pain. Hills (even the slightest incline or dip) increased the pain significantly. I have also had swollen knees. The puppy "pulling" on the leash doesn't help any. Yaktrax Cleats were

mentioned on this list, and I tried them. They however made things much much worse as I have to go over tile floors going outside (I nearly slipped no less than four times). I've been spending a great deal of time laying on my bed due to the pain, and thinking my best chance for "relief" would be to make a move to an apartment with an open patio as I had in the past (at this time, the puppy has been having a lot of "accidents" in the apartment). I have an appointment in early April in the Cleveland clinic's Center for Spine Health. This doctor is non-surgery (at the Cleveland Clinic you have to be referred to a surgeon should that be needed). Dr. Nash is now retired from doing surgeries; however, still sees patients on a limited basis in the MetroHealth Medical Center's Orthopedic Clinic (depending on what the doctor at the Cleveland Clinic says I may try to schedule an appointment with Dr. Nash).> > I was wondering if there are many

others on the list with the Non Harrington Rod Flatback Syndrome (Iatrogenically (Surgically-Induced Flatback), and what their history and symptoms may be.>

March 24, 2011

Hi .....

Refer to this link: http://www.scoliosisnutty.com/flatback-syndrome.php

S.

Re: Non Harrington Rod Flatback Syndrome (Iatrogenically (Surgically-Induced Flatback)

I find these terms to be interesting. I don't have Harrington rods. Mine are Luque instrumentation (original fusion in 1989). But my flatback didn't seem to be instantaneous. Yet my flatback revision surgeon described my flatback as iatrogenic flatback.

It makes me wonder how universal these terms actually are? Perhaps my flatback WAS created immediately during my surgery (though I specifically remember talks about the need to retain lordosis, and how bad it was earlier because docs didn't originally do this - this was from my original pediatric surgeon in 1989!), but I didn't feel off-balance right away. I think that I developed flatback at a faster rate than many Harrington people do - since most of them seem to be in their 40s, 50s and even 60s when they find these lists, and I was just 31 when I had my revision. But like I said before, these terms to describe Harrington versus iatrogenic flatback are quite interesting.

Thanks for

sharing the article! Any clue as to when Mina wrote the article?

>

> There is an outstanding Flatback Syndrome article on Scoliosisnutty.com written by beth Mina. She divides Flatback Syndrome into two types: 1) Harrington Rod - Induced Flatback and 2) Iatrogenically (Surgically-Induced Flatback). I am quoting the differences of those two types below:

>

> HARRINGTON ROD - INDUCED FLATBACK:

>

> Occurs gradually over time, allowing the body to adapt gradually to many of the changes in lordosis until a critical point is reached where there are no more ways for the body to compensate for the steadily reducing curve at the

backwaist.

> Because of the gradual change in lordosis, symptoms may not be noticed for 10-20 years.

> When at the 10-20 year point, patients realize they have become noticeably deformed, with obvious leaning-forward postures that prevent them from even raising their heads to look straight, making the condition easy for doctors to diagnose.

>

> IATROGENICALLY (SURGICALLY-INDUCED) FLATBACK:

>

> Occurs immediately on the operating table so that patients usually feel unbalanced right away while noticing that they also look different and discover they can't fit into previously-worn clothes--yet they are unable to determine exactly what is "wrong."

> Since this form of Flatback occurs all at once, the body cannot adjust to the huge sudden change of lordosis reduction, and symptoms begin occurring in 1-3 years rather than 10-20.

> Since most cases of Iatrogenically-Induced Flatback are caused in scoliosis

patients who originally had hyperlordosis (see section below on Hyperlordosis in the Spinal Fusion Patient), their new backwaist curves are NOT flat, but are just reduced to an extent that their bodies cannot tolerate; therefore they do not present as particularly deformed. (Compensatory knee bending and neck craning, unconsciously performed by the patient, may indeed make such victims look nearly normal, even to the trained eye.)

> Because these Flatback patients do not appear deformed to most doctors--even to scoliosis experts, who associate Flatback Syndrome with the "key" sign of completely flat backwaists--these patients often spend many devastating years going from doctor to doctor until they are able to obtain correct Flatback diagnoses; in the meantime, these patients are often identified mistakenly as psychiatric cases, leading to treatment with inappropriate medications and therapies, accompanied by intense frustration. (This is why

scoliosis patients are advised to ALWAYS gather and retain their x-rays, because Iatrogenic Flatback can only be 100% confirmed by spinal surgeons who can compare patients' before and after x-rays to see their changed lordosis curvatures.) 5. Because patients with Iatrogenically-Induced Flatback cases do not appear as "deformed," there is a tendency on the part of doctors--even scoliosis experts--to advise against corrective surgery even though their physical symptoms, pain, and disabling aspects are just as severe as those Flatback patients who "look" worse; therefore, their access to appropriate osteotomies can be impeded.

>

> My history is almost a mirror image of that second type. I had my surgeries in July 1996, and Sept. 1996 (second one due to loose hooks) at MetroHealth Medical Center in Cleveland, Ohio performed by Clyde L. Nash, M.D. I am fused from t9 to S1 using AcroMed Instrumentation (a generic version of Texas ish Rite

Hospital (TSRH) Instrumentation System. I was living and working in the Washington, D.C. area at the time. During about two years prior to my surgeries and about two years following my surgeries I saw T. Stinson, M.D. at Shady Grove Adventist Hospital in Rockville, land. Dr. Stinson did his spine fellowship at St. Lukes Hospital in Cleveland, Ohio. Dr. Nash was the chief of the department at St. Lukes during that time. I started having pain issues very soon after I stopped wearing the post-surgery brace. Dr. Stinson did very little to help me with those issues; however, he always asked me when I would be seeing Dr. Nash. I therefore started seeing C. Lauerman, M.D. at town University Hospital in Washington, D.C. Dr. Lauerman couldn't find a reason for my pain; however, he referred me to a Physiatrist (Physical Medicine and Rehabilitation Physician). That doctor put me on a number of non-narcotic medications. He also referred me to

physical therapy and acupuncture/acupressure treatments. None of these treatments relieved my pain. The Physiatrist referred me to a Psychiatrist who specialized in pain management. He put me on Vicoprofen and Fentanyl Patches. This did relieve my pain fairly well for a number of years; however, I often needed a higher and higher strength of the Fentanyl for the same relief. Over time, the side effects to the Fentanyl became significant (extreme nausea and my weight went down to 95 lbs.). Sitting (doing most tasks), standing, and driving also became very painful. An added issue was I began having tingling in my hand often when resting. The PCP I was seeing referred me to a neurologist in early-mid 2007. Initially, he thought I had carpal tunnel syndrome. He referred me for physical therapy; however, it didn't help. He had me get a cervical spine MRI. It showed mild to moderate DDD and disc bulges or disc herniations at all levels exept at the C6-C7

levels. The most severe was at the C3-4 level where there was a grade 1 anterolisthesis and a moderate to large size central and right paracentral disc herniation compressing my spinal cord.The neurologist then had me get an MRI on the remaining part. of my spine which only showed some minor issues. He then referred me to an orthopedic surgeon I had not seen before for a consult. He was the first to mention Flatback Syndrome (when I had an appointment with Dr. Nash in early 2008 he said that I had in since my surgeries (I had known that I had spinal arthritis at the time of my surgeries). I went began going into work less and less, until I totally stopped working, and have been on Social Security Disability and Federal Employee Disability Retirement since 2007. I moved back to Cleveland, Ohio from Washington, D.C. in late 2008. I entered the Cleveland Clinic's Outpatient Chronic Pain Rehabilitation Program (CPRP) during May 2009. I was in the CPRP for

about five weeks, and thankfully now off all narcotics. I ended up selling my car as driving made the pain overwhelming. As long as I "adjust" the way I do thing my pain is fairly well controlled. This includes leaning on something when standing. With my 15 year old dog that died back on Sept. 14th I would often lean on the patio door (or door frame) and let her out using an expandable leash. During the last year of her life that became difficult as the patio of my current apartment is enclosed. There were complaints from neighbors when I let her out on the patio. I got a Cockapoo puppy in November, and this past winter has been extremely difficult. Trying to remain standing when going in and outside in the Cleveland winter weather has resulted in major back, neck, and leg pain. Hills (even the slightest incline or dip) increased the pain significantly. I have also had swollen knees. The puppy "pulling" on the leash doesn't help any. Yaktrax Cleats were

mentioned on this list, and I tried them. They however made things much much worse as I have to go over tile floors going outside (I nearly slipped no less than four times). I've been spending a great deal of time laying on my bed due to the pain, and thinking my best chance for "relief" would be to make a move to an apartment with an open patio as I had in the past (at this time, the puppy has been having a lot of "accidents" in the apartment). I have an appointment in early April in the Cleveland clinic's Center for Spine Health. This doctor is non-surgery (at the Cleveland Clinic you have to be referred to a surgeon should that be needed). Dr. Nash is now retired from doing surgeries; however, still sees patients on a limited basis in the MetroHealth Medical Center's Orthopedic Clinic (depending on what the doctor at the Cleveland Clinic says I may try to schedule an appointment with Dr. Nash).

>

> I was wondering if there are many

others on the list with the Non Harrington Rod Flatback Syndrome (Iatrogenically (Surgically-Induced Flatback), and what their history and symptoms may be.

>

March 24, 2011

I don't post just read but this thread has at last made sense. When I had my son 6 years after my Harrington rod was fitted I complain about my posture and pain. I was told then it was all in my head and my back was now fixed. Now 31 years on I officily have flat back. But have only been diagnosed in the last 7 years yet o know what I have now is just a progression of what started 6 years after my op Sent from my iPhoneOn 24 Mar 2011, at 15:24, RSSSCOLIOSIS@... wrote:

Hi .....

Refer to this link: http://www.scoliosisnutty.com/flatback-syndrome.php

S.

Re: Non Harrington Rod Flatback Syndrome (Iatrogenically (Surgically-Induced Flatback)

I find these terms to be interesting. I don't have Harrington rods. Mine are Luque instrumentation (original fusion in 1989). But my flatback didn't seem to be instantaneous. Yet my flatback revision surgeon described my flatback as iatrogenic flatback.

It makes me wonder how universal these terms actually are? Perhaps my flatback WAS created immediately during my surgery (though I specifically remember talks about the need to retain lordosis, and how bad it was earlier because docs didn't originally do this - this was from my original pediatric surgeon in 1989!), but I didn't feel off-balance right away. I think that I developed flatback at a faster rate than many Harrington people do - since most of them seem to be in their 40s, 50s and even 60s when they find these lists, and I was just 31 when I had my revision. But like I said before, these terms to describe Harrington versus iatrogenic flatback are quite interesting.

Thanks for

sharing the article! Any clue as to when Mina wrote the article?

>

> There is an outstanding Flatback Syndrome article on Scoliosisnutty.com written by beth Mina. She divides Flatback Syndrome into two types: 1) Harrington Rod - Induced Flatback and 2) Iatrogenically (Surgically-Induced Flatback). I am quoting the differences of those two types below:

>

> HARRINGTON ROD - INDUCED FLATBACK:

>

> Occurs gradually over time, allowing the body to adapt gradually to many of the changes in lordosis until a critical point is reached where there are no more ways for the body to compensate for the steadily reducing curve at the

backwaist.

> Because of the gradual change in lordosis, symptoms may not be noticed for 10-20 years.

> When at the 10-20 year point, patients realize they have become noticeably deformed, with obvious leaning-forward postures that prevent them from even raising their heads to look straight, making the condition easy for doctors to diagnose.

>

> IATROGENICALLY (SURGICALLY-INDUCED) FLATBACK:

>

> Occurs immediately on the operating table so that patients usually feel unbalanced right away while noticing that they also look different and discover they can't fit into previously-worn clothes--yet they are unable to determine exactly what is "wrong."

> Since this form of Flatback occurs all at once, the body cannot adjust to the huge sudden change of lordosis reduction, and symptoms begin occurring in 1-3 years rather than 10-20.

> Since most cases of Iatrogenically-Induced Flatback are caused in scoliosis

patients who originally had hyperlordosis (see section below on Hyperlordosis in the Spinal Fusion Patient), their new backwaist curves are NOT flat, but are just reduced to an extent that their bodies cannot tolerate; therefore they do not present as particularly deformed. (Compensatory knee bending and neck craning, unconsciously performed by the patient, may indeed make such victims look nearly normal, even to the trained eye.)

> Because these Flatback patients do not appear deformed to most doctors--even to scoliosis experts, who associate Flatback Syndrome with the "key" sign of completely flat backwaists--these patients often spend many devastating years going from doctor to doctor until they are able to obtain correct Flatback diagnoses; in the meantime, these patients are often identified mistakenly as psychiatric cases, leading to treatment with inappropriate medications and therapies, accompanied by intense frustration. (This is why

scoliosis patients are advised to ALWAYS gather and retain their x-rays, because Iatrogenic Flatback can only be 100% confirmed by spinal surgeons who can compare patients' before and after x-rays to see their changed lordosis curvatures.) 5. Because patients with Iatrogenically-Induced Flatback cases do not appear as "deformed," there is a tendency on the part of doctors--even scoliosis experts--to advise against corrective surgery even though their physical symptoms, pain, and disabling aspects are just as severe as those Flatback patients who "look" worse; therefore, their access to appropriate osteotomies can be impeded.

>

> My history is almost a mirror image of that second type. I had my surgeries in July 1996, and Sept. 1996 (second one due to loose hooks) at MetroHealth Medical Center in Cleveland, Ohio performed by Clyde L. Nash, M.D. I am fused from t9 to S1 using AcroMed Instrumentation (a generic version of Texas ish Rite

Hospital (TSRH) Instrumentation System. I was living and working in the Washington, D.C. area at the time. During about two years prior to my surgeries and about two years following my surgeries I saw T. Stinson, M.D. at Shady Grove Adventist Hospital in Rockville, land. Dr. Stinson did his spine fellowship at St. Lukes Hospital in Cleveland, Ohio. Dr. Nash was the chief of the department at St. Lukes during that time. I started having pain issues very soon after I stopped wearing the post-surgery brace. Dr. Stinson did very little to help me with those issues; however, he always asked me when I would be seeing Dr. Nash. I therefore started seeing C. Lauerman, M.D. at town University Hospital in Washington, D.C. Dr. Lauerman couldn't find a reason for my pain; however, he referred me to a Physiatrist (Physical Medicine and Rehabilitation Physician). That doctor put me on a number of non-narcotic medications. He also referred me to

physical therapy and acupuncture/acupressure treatments. None of these treatments relieved my pain. The Physiatrist referred me to a Psychiatrist who specialized in pain management. He put me on Vicoprofen and Fentanyl Patches. This did relieve my pain fairly well for a number of years; however, I often needed a higher and higher strength of the Fentanyl for the same relief. Over time, the side effects to the Fentanyl became significant (extreme nausea and my weight went down to 95 lbs.). Sitting (doing most tasks), standing, and driving also became very painful. An added issue was I began having tingling in my hand often when resting. The PCP I was seeing referred me to a neurologist in early-mid 2007. Initially, he thought I had carpal tunnel syndrome. He referred me for physical therapy; however, it didn't help. He had me get a cervical spine MRI. It showed mild to moderate DDD and disc bulges or disc herniations at all levels exept at the C6-C7

levels. The most severe was at the C3-4 level where there was a grade 1 anterolisthesis and a moderate to large size central and right paracentral disc herniation compressing my spinal cord.The neurologist then had me get an MRI on the remaining part. of my spine which only showed some minor issues. He then referred me to an orthopedic surgeon I had not seen before for a consult. He was the first to mention Flatback Syndrome (when I had an appointment with Dr. Nash in early 2008 he said that I had in since my surgeries (I had known that I had spinal arthritis at the time of my surgeries). I went began going into work less and less, until I totally stopped working, and have been on Social Security Disability and Federal Employee Disability Retirement since 2007. I moved back to Cleveland, Ohio from Washington, D.C. in late 2008. I entered the Cleveland Clinic's Outpatient Chronic Pain Rehabilitation Program (CPRP) during May 2009. I was in the CPRP for

about five weeks, and thankfully now off all narcotics. I ended up selling my car as driving made the pain overwhelming. As long as I "adjust" the way I do thing my pain is fairly well controlled. This includes leaning on something when standing. With my 15 year old dog that died back on Sept. 14th I would often lean on the patio door (or door frame) and let her out using an expandable leash. During the last year of her life that became difficult as the patio of my current apartment is enclosed. There were complaints from neighbors when I let her out on the patio. I got a Cockapoo puppy in November, and this past winter has been extremely difficult. Trying to remain standing when going in and outside in the Cleveland winter weather has resulted in major back, neck, and leg pain. Hills (even the slightest incline or dip) increased the pain significantly. I have also had swollen knees. The puppy "pulling" on the leash doesn't help any. Yaktrax Cleats were

mentioned on this list, and I tried them. They however made things much much worse as I have to go over tile floors going outside (I nearly slipped no less than four times). I've been spending a great deal of time laying on my bed due to the pain, and thinking my best chance for "relief" would be to make a move to an apartment with an open patio as I had in the past (at this time, the puppy has been having a lot of "accidents" in the apartment). I have an appointment in early April in the Cleveland clinic's Center for Spine Health. This doctor is non-surgery (at the Cleveland Clinic you have to be referred to a surgeon should that be needed). Dr. Nash is now retired from doing surgeries; however, still sees patients on a limited basis in the MetroHealth Medical Center's Orthopedic Clinic (depending on what the doctor at the Cleveland Clinic says I may try to schedule an appointment with Dr. Nash).

>

> I was wondering if there are many

others on the list with the Non Harrington Rod Flatback Syndrome (Iatrogenically (Surgically-Induced Flatback), and what their history and symptoms may be.

>

March 24, 2011

You can also find Mina's writing at our site. Go to the

website, click on " Files " in the lefthand column, and

you will bring up a list of resources including 's articles.

> >

> > There is an outstanding Flatback Syndrome article on Scoliosisnutty.com

written by beth Mina. She divides Flatback Syndrome into two types: 1)

Harrington Rod - Induced Flatback and 2) Iatrogenically (Surgically-Induced

Flatback). I am quoting the differences of those two types below:

> >

> > HARRINGTON ROD - INDUCED FLATBACK:

> >

> > Occurs gradually over time, allowing the body to adapt gradually to many of

the changes in lordosis until a critical point is reached where there are no

more ways for the body to compensate for the steadily reducing curve at the

backwaist.

> > Because of the gradual change in lordosis, symptoms may not be noticed for

10-20 years.

> > When at the 10-20 year point, patients realize they have become noticeably

deformed, with obvious leaning-forward postures that prevent them from even

raising their heads to look straight, making the condition easy for doctors to

diagnose.

> >

> > IATROGENICALLY (SURGICALLY-INDUCED) FLATBACK:

> >

> > Occurs immediately on the operating table so that patients usually feel

unbalanced right away while noticing that they also look different and discover

they can't fit into previously-worn clothes--yet they are unable to determine

exactly what is " wrong. "

> > Since this form of Flatback occurs all at once, the body cannot adjust to

the huge sudden change of lordosis reduction, and symptoms begin occurring in

1-3 years rather than 10-20.

> > Since most cases of Iatrogenically-Induced Flatback are caused in scoliosis

patients who originally had hyperlordosis (see section below on Hyperlordosis in

the Spinal Fusion Patient), their new backwaist curves are NOT flat, but are

just reduced to an extent that their bodies cannot tolerate; therefore they do

not present as particularly deformed. (Compensatory knee bending and neck

craning, unconsciously performed by the patient, may indeed make such victims

look nearly normal, even to the trained eye.)

> > Because these Flatback patients do not appear deformed to most doctors--even