Flat Back

Fixed flatness of lumbar lordosis and lumbar kyphosis ("board symptom", "flat back") is one of the brightest manifestations of lumbar osteochondrosis, this symptom relatively attracted the attention of some authors, while others did not pass by another deformation - scoliosis. This is explained, apparently, by the great fl exibility of the last deformation, and also by the fact that scoliosis was more logically connected with one-sided "sciatica", "radiculitis" more than kyphosis. When the vertebrogenic nature of the disease was established, the vertebrogenic syndrome and, in particular, the flattening of lordosis became the object of attention of all clinicians.

The severity of the symptom of smoothness of lordosis or kyphosis was associated earlier with the "expediency" of this device. Extension of the lumbar spine in the presence of herniated disc leads to an increase in pressure on the posterior sections of the fibrous ring and the posterior longitudinal ligament, and often also on the spine. In the presence of a disc herniation, these irritations of the fibrous ring, posterior longitudinal ligament or spine are possible already in the normal position of the lumbar region - with normal lordosis. Reduction of this lordosis, and even more so the formation of kyphosis, under such conditions is a protective posture. With respect to the cervical level, the possibility of kyphosis is indicated by shortening or increasing the tone of the front muscles of the neck, especially among athletes.

With kyphosis, the posterior sections of the fibrous ring are stretched and this stretching leads to a decrease in protrusion of the disc posteriorly. However, this decrease in protrusion is possible only if it is small and if the fibers of this ring retain their integrity. When the fiber of the fibrous ring breaks, the prolapse of the intervertebral nucleus with the torso inclined forward usually does not decrease, but increases.

Thus, the lumbar kyphotic system is only partially and only under certain circumstances, can be considered as a protective compensatory, ensuring the repositioning of the bulging fibrous ring and reducing the irritation of the posterior longitudinal ligament or even reducing the compression of the spine. It should be noted that in kyphosis, the posterior longitudinal ligament, like the posterior sections of the fibrous ring, undergo stretching. Capsules of the intervertebral joints also undergo the same stretching. If flexion were an exceptionally "protective" setting, it would be difficult to understand why patients with a "syndrome" of lumbar osteochondrosis are so afraid of this posture: with additional torso inclinations forward (especially when exercising), lumbar pains and leg pains intensify. Moreover, the slopes forward are one of the most famous poses that provoke the disease. That is why with the inclinations forward and stimulation of the receptors of various tissues of the spine, in a number of cases there is a reflex contraction of the muscles - the extensors of the loin with fixation of the reverse posture - of fixed hyperlordosis. Whether this extensor pose or flexion will prevail, other things being equal, depends on which of the two reflexes will prevail.

Fixation of such an installation is accompanied by severe pain; it also aggravates and possible radicular compression. Nevertheless, moderate kyphosis or rectification of lordosis is a more favorable setting (for good reason traumatologists and neurosurgeons create this pose artificially in spinal fusion surgery). It is formed more often than others due to its "expediency", but due to the objectively developing conditions in patients suffering from osteochondrosis of the lumbar spine.

[1], [2]