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Wide Abdominal Rectus Plication Abdominoplasty for the Treatment of Chronic Intractable Low Back Pain

Oneal, Robert M. M.D.; Mulka, Joseph P. M.D., Ph.D.; Shapiro, Paul M.D.; Hing, David M.D.; Cavaliere, Christi M.D.

Plastic & Reconstructive Surgery: January 2011 - Volume 127 - Issue 1 - pp 225-231
doi: 10.1097/PRS.0b013e3181fad2f7
Reconstructive: Trunk: Original Articles
Discussion

Background: A previous report demonstrated that the wide abdominal rectus plication abdominoplasty is an effective treatment modality in select patients with low back pain who failed to achieve relief with conservative therapy.

Methods: The authors studied eight female patients who presented with chronic low back pain and marked lower abdominal wall muscular laxity. All had failed to respond to conservative management for their chronic back pain. They all underwent wide abdominal rectus plication abdominoplasty. Patient selection and details of the procedure are discussed.

Results: There were no significant complications in this series, and all the patients had prompt and prolonged alleviation of their back pain. Length of follow-up ranged from 2 to 11 years.

Conclusions: Changes in the biomechanics of the lower abdominal musculature as a result of the wide abdominal rectus plication abdominoplasty are discussed in the context of increasing spinal stability, leading to an alleviation of chronic low back pain. An argument is made that this abdominoplasty procedure produces a spine-stabilizing effect by (1) tightening the muscles of the lateral abdominal complex and thus increasing intraabdominal pressure and (2) increasing the efficiency of these muscles so that their effectiveness as spine stabilizers is increased. Even though this is a small series, the fact that all the patients sustained long-term alleviation of their preoperative chronic back pain suggests that the wide abdominal rectus plication abdominoplasty should be considered as an option for patients with weak lower abdominal muscles and intractable low back pain who have failed conservative management.

Ann Arbor, Mich.; and Rochester, Minn.

From the University of Michigan Medical Center; the Sections of Physical Medicine and Rehabilitation and Plastic Surgery, St. Joseph Mercy Hospital; and the Department of Physical Medicine and Rehabilitation, Mayo Clinic.

Received for publication February 11, 2010; accepted June 28, 2010.

Disclosure: The authors have no financial disclosures or commercial affiliations to report in relation to the content of this article.

Robert M. Oneal, M.D.; 501 Onondaga Street; Ann Arbor, Mich. 48104; boboneal@comcast.net

©2011American Society of Plastic Surgeons