Diastasis and Spinal Fusion

Question

I had spinal fusion as a teen and currently have 3 children (two c sections). I've experienced lower back pain and was wondering if the weight from my stomach (its heavy) was affecting my spine. I saw a plastic surgeon today hoping to get liposuction and was told that I have severe diastasis recti. I don't want to get a tummy tuck but I am worried about the long term affect that the weight (from my stomach) will have on my spine. If it does affect my spine fusion will insurance cover the tummy tuck?

Vincent N. Zubowicz, MD · Answer

Some patients after abdominoplasty say that lower back issues or improved. Clinical support for this is quite weak and I would proceed with abdominoplasty with the expectation that it will be cosmetic only.

Manuel M. Peña, MD · Answer

Consider your upright posture as a sailboat and your spine as the mast. Ligaments connecting your vertebra and the musculature of your back and abdomen are the "lines" keeping it upright. Keeping these strong with exercises designed to build your "core" (such as yoga and Pilates) will give you the best chance of leading a pain free life. Occasionally, the diastasis is so wide that the efficiency of the rectus abdominus muscle is affected and diminished. In these rare cases, i have fond it necessary to repair the diastasis! Oh by the way... keep your psoas and gluteal muscles stretched!

Jourdan Gottlieb, MD · Answer

Thank you for your question. 

	There is little evidence that diastasis recti causes symptoms or contributes to any health problems, and for that reason it is extremely unusual for an insurance carrier to cover a tummy tuck. 

	Any decision you make should be based on expected improvement in appearance. Neither liposuction nor tummy tuck is a useful procedure for weight loss. 

	All the best.

Jeffrey Zwiren, MD · Answer

It is known that for every 1 pound of weight in the front and lower abdomen transfers 10 pounds to the lower lumbar spine. Lack of fascial support of the lower abdomen can also lead to lower back problems. It is possible in rare circumstances that insurance may cover part of the procedure but I would suspect that it will be considered cosmetic and not covered.

Tom J. Pousti, MD · Answer

Thank you for the question.  Based on your description and history, it sounds like your plastic surgeon consultant has given you good advice. The vast majority of patients I see  after 3 children are not good candidates for liposuction surgery alone.

	 There is no way of knowing whether tummy tuck surgery will necessarily help your spine condition.  I think you should proceed with tummy tuck surgery ONLY IF  you are concerned about excess skin/adipose tissue along with the presence of the diastasis;  the presence of the spine condition will probably should not be influential.

	Furthermore, it is unlikely, despite your history, that insurance companies will cover the procedure. Of course, to be sure, you should check with the specific insurance company.

	Best wishes.

Gregory J. Stagnone, MD (retired) · Answer

There was an article published in the '90s suggesting that abdominoplasty with rectus diastasis repair might help with back pain but it has never been accepted as a treatment for back pain or to preserve a fusion. If you want and abdominoplasty, it will be virtually certain that you'll have to do so with your own finances. Also, although I have seen some patients have an improvement in some back discomfort, there is no guarantee, so I would only do it if you are also very interested in the aesthetic and restorative benefits, not just in hopes of a positive effect on your spine. Hope this helps. Best of luck!

Diastasis and Spinal Fusion

Answers (6)

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