The importance of an intact abdominal musculature mechanism in maintainingspinal sagittal balance - Case illustration in prune-belly syndrome

Study Design. A rare case of thoracic hypokyphotic deformity secondary to p rune-belly syndrome is presented, Objectives. To discuss the role of an intact abdominal musculature mechanis m in maintaining spinal sagittal balance, and to present a case illustratio n of prune-belly syndrome. Summary of Background Data. There has been an ongoing debate concerning the integrity of the abdominal musculature unit in maintaining spinal support and stability. It is now believed that intra-abdominal pressure hitherto ge nerated plays an important role in the stabilization of the spine. Congenit al aplasia of the abdominal musculature, termed prune-belly syndrome, might therefore result in the loss of spinal function and stability. The literat ure also is reviewed for the incidence of spinal deformities related to thi s condition. Methods. A unique case of prune-belly syndrome in a 33-year-old man with co ngenital aplasia of the abdominal musculature is presented. Results. The patient exhibited loss of the spinal sagittal balance, with re sultant development of a thoracic hypokyphotic deformity and thoracolumbar scoliosis, Conclusions. Scoliosis appears to be the most commonly reported spinal defo rmity. Unequal compressive forces on the vertebral endplates may be the pro posed mechanism for the spinal deformities. Compensatory lumbar paraspinal overactivity resulting from the inability to generate normal intra-abdomina l pressures because of a deficient abdominal wall musculature mechanism see ms to be the plausible explanation for the observed thoracic hypokyphotic d eformity.