This is a short article written in French in 1953 by Rimbaud and Thevenet, French doctors, about the lipome épisacro-iliaque and lombo-sciatique (French name for back mice and lumbosciatalgia).

They briefly mention others authors’ works. Some French, such as Sicard and Lord (1952), the American Reis (1937), and Ficarra and MacLaughin, or the well-known English publications from Copeman and Ackerman (1944).

They also present a case report about a woman that suffered from long incapacitating low back pain until it could be found and treated, due to back mice or a lumbar painful fatty nodule. The patient presented a L5 type lumbosciatic pain syndrome in relation to a fatty nodule of the sacroiliac region. The treatment of lipoma by 5 novocainic infiltrations (separated by a week) resulted in healing while all the methods that had been undertaken before failed.

They suspect that the etiopathogenic factors are a disturbance in the water balance. But they do not discuss deeper about it.

 Lombo-sciatique et lipome épisacro-iliaque

[Lumbar Sciatica and Lipoma of the Sacroiliac Region].

By P. RIMBAUD and A. THEVENET

The association between lumbosciatic pain and some fatty nodules (or back mice)

The authors started their article by commenting that the presence of fatty nodules of the sacroiliac region may seem a banal finding. But if these small lipomas are responsible for low back pain or lumbosciatic pain, the fact becomes worthy of interest, especially as a simple therapy can lead to healing.

Main characteristics of the “lipome épisacro-iliaque” (or back mice)

The “lipome épisacro-iliaque” is mainly observed in the adult after the 40s, a little more often in women. They can be single or multiple, unilateral or bilateral, it presents itself as a rounded mass, from the volume of a nut to that of a walnut, sitting at the upper part of the buttock in the lateral region of the Michaelis rhombus, free and mobile on the different planes.

Main symptoms of the “lipome épisacro-iliaque” (or back mice) the “lombo-sciatique”

The associated signs may be either the type of pure lumbago or lumbosacralgia, or the type of lumbosciatica with characteristic irradiation.

The major sign, to link the lipoma to the pain syndrome, is that it can be triggered by the pressure of the nodule, and then the patient feels the usual pain with its characteristics and its irradiation.

Treatment of the “lipome épisacro-iliaque” and the “lombo-sciatique”

The treatment is simple. First, they performed a DIAGNOSTIC TEST by infiltration of novocaine at 1% around the nodule or nodules. The injection can be curative especially if they performed the injection in the center of the nodule by perforating it with the purpose to distend it and dilate it (Copeman’s technique). This technique can give sometimes spectacular results and the disappearance of pain and the fatty nodule itself.

In certain cases, surgical removal can be done.

The benignity of these diagnostic methods justifies them as a therapeutic test in low back pain without apparent cause.

Rimbaud and Thevenet CASE REPORT about “lipome épisacro-iliaque” and “lombo-sciatique”

 

A 55-year-old woman began to complain of low back pain in 1948. In 1950, low back pain increased and irradiation in the lower right limb resulted in difficulty and pain in walking, requiring the help of a doctor.

These pains motivated her hospitalization in several hospitals, where successive treatments were undertaken without success: vertebral traction, wearing of a lumbar corset, radiotherapy, ultra sounds. A “greffe vertébrale” was even considered, but refused.

Hospitalized in February 1953, the patient still suffers from lumbar pain with irradiation at the level of the right hip, the external surface of the thigh and the leg, and sometimes even the big toe on the back of the foot. Pain accentuated with cough and especially with the effort (prolonged walking, stair climbing).

Somatic examination: mild truncal obesity (thorax, flanks and loins), erythrose of the face, and vaso-motor disorders of the right limbs. Patella and Achilles reflexes normal. The palpation of the lumbar spine reveals pain at the level of L5.

The more careful exploration of this region, while standing, allows to discover a small mass of lipomatous consistency, the volume of a large almond, limited, mobile on the superficial and deep plane, rolling under the finger and located in the outer part of the Michaelis rhombus, at the right edge of L5.

The displacement of this nodule on the deep plane causes the reproduction of the pain spontaneously felt by the patient with its usual irradiation. The symmetrical examination on the other side shows nodules of the fatty tissue without individualisation of a limited and painful mass. The rest of the exam is negative. The radiographs of the lumbar spine show no lesions likely to cause this pain syndrome, except for mild scoliosis and very discrete osteoarthritis.

A therapeutic test is undertaken by infiltration of novocaine at 1% around and in the nodule itself. The pain relief for several days is achieved by the intralipomatous injection treatment by perforating the capsule.

Five infiltrations were carried out, about a week apart, the pains quickly gave way and the lipomatous nodule diminished considerably, its volume being currently that of a pea. The healing has continued since, the patient walks without a cane and climbing the stairs no longer triggers the painful phenomena.

Some etiopathogenic theories from the authors

The pathogenesis of this curious syndrome is far from being elucidated. Considered by some to be a fatty hernia through the lumbar-dorsal fascia, the majority of authors make this nodule an endocrine manifestation determining vasomotor disorders and storage of water by the adipose tissue.

Final conclusions

The simplicity and the benignity of the treatment, likely to bring about a cheap cure, deserves that one looks for this lipoma in the presence of a pain of the lower back of undetermined origin, and that one tries the therapeutic test. Which, in case of failure, does not exclude the implementation of other methods.

Published in October 2018 By Marta Cañis Parera     

Article’s reference

RIMBAUD P, THEVENET A. [Lumbar sciatica and lipoma of the sacroiliac region]. Montp Med. 1953 Aug; 44(2):125-7. Undetermined Language. PubMed PMID: 13119727.

Other references

• Reis (1937)
• Copeman and Ackerman (1944)
• Carling and Ross (1948)
• Rubens-Duval. Cellulalgie (1950)
• Ficarra and McLaughin (1952)