(Kiosk 5) Improvement in Visual Analogue Scale (VAS) and Subjective Back Support After Surgical Repair of Ventral Hernia in a Patient with Chronic Low Back Pain

Case Diagnosis: Ventral Hernia due to diastasis recti

Case Description or Program Description: A 50-year-old male with past medical history of hypertension, gastroesophageal reflux disease, diverticulitis, cervical fusion presented to an outpatient spine clinic with chronic left sided low back pain (LBP). Physical exam and imaging are supportive of lumbar facetogenic pain at L4/5 and L5/S1 levels, primarily at the left side. A ventral hernia due to abdominal diastasis recti was identified during the exam and confirmed by ultrasound. He underwent a radiofrequency ablation (RFA) for his left L4/5 and L5/S1 facet arthropathy after positive response to comparative diagnostic blocks of medial branch nerves to L4/5 and L5/S1 facets, and he reported a significant relief of LBP. A subsequent surgical repair of ventral hernia has resulted in additional improvement of LBP.

Setting: Outpatient spine center at an academic institution

Assessment/Results: At 6 weeks after his ventral hernia repair with mesh and RFA intervention on his lumbar spine, the patient reported an improvement of VAS score from a 6/10 to a 0/10. Additionally, he noted increased back support after the ventral hernia repair specifically. Further findings will be discussed.

Discussion (relevance): LBP is commonly caused by disc, facet, and muscle complications. Myofascial pain can be related to core muscle weakness, and core muscle deconditioning is a well-known contributing factor to low back pain. In this case report, we explored how repair of a ventral hernia can help relieve LBP.

Conclusions: Ventral hernias are rarely reported causes of lower back pain. Their connection may be attributed to the laxity of transverse abdominis muscle. Ventral hernias are often easily ignored due to the lack of imaging techniques and the unreliability of clinical examination alone to make the diagnosis. This case report highlights when encountering chronic LBP in patients, clinicians should perform a thorough abdominal exam to elucidate any previously missed hernias or core muscle weakness that may be contributing to the patient’s back pain.