title: Wide abdominal rectus plication abdominoplasty for the treatment of chronic intractable low back pain.
abstract: 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.
authors.affiliation: 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.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Oneal
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Mulka
authors.forename: Paul
authors.initials: P
authors.lastname: Shapiro
authors.forename: David
authors.initials: D
authors.lastname: Hing
authors.forename: Christi
authors.initials: C
authors.lastname: Cavaliere
mesh_terms: D000009:Abdominal Muscles / Q000503:physiopathology / Q000601:surgery*; D000328:Adult; D001696:Biomechanical Phenomena; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000601:surgery*; D008875:Middle Aged; D018579:Patient Selection; D019651:Plastic Surgery Procedures / Q000379:methods*; D013131:Spine / Q000502:physiology