AN ASSOCIATION BETWEEN THE FLAT BACK AND POSTPOLIO SYNDROMES - A REPORT OF 3 CASES

The cases of three patients with a history of paralytic poliomyelitis in childhood who developed the flat back syndrome before or after spin al fusion for degenerative disease as adults were reviewed. The flat b ack syndrome, a combination of an inability to stand erect because of forward flexion of the trunk and pain in the low back and/or legs, typ ically occurs in the setting of decreased lumbar lordosis as a result of distraction instrumentation of the spine for scoliosis, vertebral f racture, or degenerative disease. Focus was placed on determining the factors responsible for the development and/or persistence of the flat back syndrome in these patients despite maintenance of, or partial op erative restoration of, lumbar lordosis. Considering the essential rol e that the trunk extensor musculature plays in maintaining upright pos ture, it may be that a new onset of weakness (postpolio syndrome) in t his musculature represents a major contributing factor to the flat bac k syndrome in these patients. Spine surgeons considering operative pro cedures in patients with a remote history of paralytic poliomyelitis s hould be aware of the possible increased risk of the flat back syndrom e in this population of patients. (C) 1997 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.