Leaning Forward When You Stand or Walk

Common questions

Can sagittal imbalance be managed without surgery?

Often, yes, at least for a substantial period. When the deformity is flexible and pain is the main problem, a supervised program of core and gluteal strengthening, postural training, treatment of underlying osteoporosis, and activity modification can provide meaningful relief. Surgery is reserved for fixed, disabling malalignment that does not respond to non-operative care.

Can flatback syndrome improve without surgery?

Conservative care, including physical therapy for hip flexibility and core strengthening, pain medication, and treatment of osteoporosis, can meaningfully reduce symptoms and help patients function better. These measures address the muscular and symptomatic burden of the deformity; they do not correct the underlying loss of lumbar lordosis. Patients whose deformity is fixed and disabling, or who develop progressive neurologic problems, are those most likely to need surgical correction.

Is adult spinal deformity always progressive?

Natural history is variable. Curves with significant rotatory subluxation and progressive sagittal imbalance tend to worsen and are associated with declining function and quality of life, but not all deformities progress at the same rate. Regular monitoring alongside attention to bone health and core muscle conditioning is an important part of ongoing management.

Is adult degenerative scoliosis the same as the scoliosis children are screened for?

No. Adult degenerative scoliosis, also called de novo scoliosis, arises in a spine that was straight in adolescence. It develops from asymmetric wear of the discs and facet joints rather than from a constitutional curve carried from youth, and it is primarily a disorder of older adults.

Do vertebral compression fractures heal on their own?

The natural history of an uncomplicated osteoporotic compression fracture is generally favorable, with pain improving over six to twelve weeks as the fracture consolidates. However, treating the underlying osteoporosis with calcium, vitamin D, and appropriate medications is equally important to reduce the substantial risk of future fractures.

Does spinal stenosis always get worse?

Not necessarily. The natural history is typically slowly progressive or stable, and many patients remain functionally manageable for years with non-operative care.