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stenosis corrected certain issues; it
relieved my lower back pain and
leg pain for a while, " he says. " But
by 2019, when I was referred to
Dr. Smith, I couldn't walk or stand
without pain and I went up two
pant sizes because I was leaning so
far forward. "
" Mr. Florindi had a previous
lumbar fusion surgery, which
permanently connects two or
more vertebrae in the spine and
limits movement and friction
between them, " Dr. Smith explains.
" Unfortunately, this surgery flattened out his back too much, which
made it hard for him to stand up,
and it put stress on the junctions
above and below the inserted
rods and screws, causing them to
wear down. "

SUCCESSFUL
RECONSTRUCTION
" We see a fair number of
patients like Mr. Florindi at
UVA who require revision
surgeries, " Dr. Smith adds.
" Cases like these emphasize
the importance of making sure the
alignment and curvature of the
spine is as good as we can get it
even when we're doing a smaller
fusion procedure. "
Dr. Smith does a high volume of
these smaller spine surgeries, those
that fuse shorter sections of the
spine. He's done extensive research
on how to make these procedures
safer and limit the need for future
surgeries. Fortunately for Florindi,
Dr. Smith is also skilled at reconstructing the spine when surgeries
fail to withstand the test of time.
" I was originally told the repairs
needed were too extensive to fix, "
Florindi says. " But when I met
with Dr. Smith, he spent over an
hour talking to me about my condition, and he came up with an
action plan. "
His treatment plan included
two complex surgeries done five
days apart: one to revise the initial
lumbar fusion and a 12-hour procedure to realign the spine. " We

At UVA Health

, spine surgeons
carefully consider the curve of the spine to
reduce the risk of flatback syndrome and
more pain in the future.

had multiple goals, " Dr. Smith says.
" One goal was to decompress or
free up the nerves where there was
stenosis to try to relieve his leg pain.
The other was to get him standing
up straighter. "
Five days after the two surgeries, Florindi was doing physical
therapy. Recovery time varies for
each patient, Dr. Smith says. " I typically tell patients that it will take
several weeks to recover from big
surgeries like this, " he says. " I think
Mr. Florindi's recovery was better
than average. "
As with any surgery, there are
risks involved, such as infection
and excess bleeding. Those risks
increase when a patient is advanced
in age. Yet, for people like Florindi,

the benefits far outweigh the risks.
" Quality of life is important, and
Mr. Florindi was moving in the
wrong direction, " Dr. Smith says.
Florindi says, " I didn't feel that
there was any other option. There
was nothing else we could do to
prevent pain and give me the ability
to stand up straight. I feel that 70 is
still young and having the surgery
would keep me from missing out on
years of activity and fun. "
For Florindi, fun equals golf. And
today, just over a year after surgery,
he's back on the green four days a
week. " I'm out there enjoying the
sun and the fact that I can stand up
straight, and I owe it to the doctors,
nurses and staff at UVA, " he says.
" Everyone there was just super. " *

At Risk for Flatback Syndrome?
The spine has a natural " S " shape that helps support the weight of the
body and keep it upright. When that natural curvature is compromised and
the back straightens or ﬂattens, it affects the body's alignment and can
cause pain.
People with ﬂatback syndrome have a stooped posture and must strain to
stand upright. " They are forced to use muscles abnormally to compensate, which
isn't sustainable, " says UVA Health spine surgeon Justin Smith, MD. This muscle
strain causes pain in the back, legs and neck that worsens over time.
Natural causes of ﬂatback syndrome are common among older adults. These
include degenerative disk disease, compression fractures and ankylosing spondylitis
(a form of arthritis in the spine).
Another common cause is a history of spine surgeries, including spinal fusion
surgery and laminectomy. Surgeons who carefully consider the curve of the spine
and alignment during these procedures can reduce the risk of ﬂatback syndrome
in the future, Dr. Smith says.
Symptoms of many degenerative spine conditions can be managed with medication and physical therapy. Patients with ﬂatback syndrome, however, will
require surgery to restore their posture and relieve pain.

Find Freedom from Pain
Painful spine conditions often can be treated with medication,
physical therapy or other nonsurgical therapies. But when surgery is the
only option, UVA Health spine surgeons carefully consider the curve of the
spine to reduce the risk of more pain in the future. See all of UVA's spine
services at uvahealth.com/spine.

VIM & VIGOR SPRING 2021

http://www.uvahealth.com/spine

Vim & Vigor - Spring 2021

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