rmoreMemberOctober 28, 2012 at 4:17 amPost count: 2
I had a spinal fusion surgery about two months ago after an accidental fall that fractured my L1 vertebra. The surgery involved making a cut on my left side just below the rib cage. Things have been going good so far pain-wise but I am puzzled by the bloating on the left side of my abdomen. The distention is such that my navel is offset by an inch or two to the right.
Can anybody please tell me why this bulge in my left abdomen has occurred…will it ever go away….what should I do to make it go away? i am a 29 year old healthy male and I generally do not have much fat on my belly. I also used to be able to breathe in deeply and pull in my stomach doing thus….but now after the surgery I cannot. This distention is very uncomfortable and gives me a very ‘tight and stretched’ feeling in my abdomen.
Thanks in advance for the replies and advice.
RmoreDr. CorenmanModeratorOctober 29, 2012 at 1:45 amPost count: 3683
You had an anterior approach to the spine. An incision on the left requires cutting some abdominal muscles and these muscles will not heal and function as before the surgery. This abdominal wall weakness has two separate consequences.
One is that the opposite side muscle will continue to pull with regular strength and the surgical side muscles will have less “pull” (strength is diminished by the incision). This imbalance will pull the midline off center (as marked by the umbilicus or navel).
The second consequence is that the abdominal wall on that side will bulge somewhat with the complaint of “bloating”.
“Core” therapy work to try and rebalance the abdominal wall may yield some symptom relief. Make sure you have a consult with the original general surgeon who made the initial incision and approach to make sure there is nothing wrong (abdominal wall hernia).
Dr. CorenmanPLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.rmoreMemberJanuary 31, 2013 at 9:15 amPost count: 2
Thank you Dr. Corenman.
I had a consult with the surgeon who actually made the side incision. He said everything looks fine (!) and that there is no hernia.
So after searching and reading over the internet I have gathered some knowledge which seems to match with what you say. I now understand that some nerve is cut during the making of the incision (intercostal nerve?) which leads to denervation of the flank. (I have lost a lot of sensation around the incision). This also leads to weakening of the flank muscles and they lose their contracting ability. Hence the flank bulge.
Sure there must be something to ‘take care’ of this bulge? It is very inconvenient and unsightly and a nuisance when I am up and about. My surgeon recommends to go see a plastic surgeon.
Would this be a good move? Can a plastic surgeon resolve my bulge issue by an abdominoplasty or something?
Was there a worthwhile reason as to why my surgeon preferred to go thru the sides and not the front? I feel going thru the front would not have caused any bulge issue while still being able to put the required hardware in me.
RmoreDr. CorenmanModeratorJanuary 31, 2013 at 10:04 amPost count: 3683
First, give the abdominal wall some time to heal. The muscles can recover and the nerve can also recover. After about one year if you are not satisfied, you might consult a specialist surgeon for an abdominal wall consult. I am not sure that a plastic surgeon would be the one. There is a condition called rectus diastasis which might be repaired by this type of specialist and this condition might be somewhat similar to the type of repair you might desire.
Since in the typical anterior approach, only one nerve is “stretched”, this should not weaken the entire abdominal wall. The wall is innervated by six nerves. One nerve should not cause too much weakness.
Dr. CorenmanPLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.rmoreMemberJanuary 31, 2013 at 11:23 amPost count: 2
Thank you so much, Dr. Corenman. I really appreciate you taking out time to reply to my questions and decrease my anxiety.
One last question though – Is it possible to injure the nerve (one or some of the nerves that innervate the abdomen flank muscles) without the incision? The reason I ask this is because after my accident (I fell down 20 ft and the spinal canal was compromised 80%) and BEFORE the surgery, I once noticed that I had heavy spasms in my left abdomen. I also saw that my left abdomen had bulged. At that time I attributed the bloating to the Naproxen dosage that the ER gave me.
So is it possible that those nerves would have been hurt by my fall which led to the bloating? And the surgical operation just aggravated the bloating?
Thanks a lot.
RmoreDr. CorenmanModeratorJanuary 31, 2013 at 8:02 pmPost count: 3683
I have never seen 3-4 thoracic nerve roots injured all in a row without a cord injury but I guess anything is possible. I would highly suspect that there might be something else going on with the abdominal wall such as direct trauma to the muscle.
Do not be too impatient with this. Give it some time and you might be surprised by the results.
Dr. CorenmanPLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
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