Notes on the article:

One of the many names with which back mice has been described is herniation of fat that occurs through the lumbodorsal fascia.

This article is a SHORT CASE REPORT from 1954 from Boston about a woman with unexplained incapacitating low back pain that was proven to be due to herniation of fat through a defect of lumbodorsal fascia.

The authors thought it was important to publish this case so that the medical community could learn from it. So the case and its history could be duplicated many times.

They warn that the syndrome caused by the “herniation of fat” SHOULD BE CONSIDERED more often in the differential diagnosis of low back pain.

The case report is about an elderly obese female who complained of incessant incapacitating low back pain. She was treated in different hospitals and by different physicians and was diagnosed with “osteoarthritis of the spine”.

They proved that the cause of low back pain was herniation of fat through the lumbodorsal fascia with complete relief after removing the herniation of fat and repairing the fascia.

The removal of the fat mass was quite simple and gave her complete relief for at least 6 months after the publication of the article.

They mention a 3 cm defect from the lumbodorsal fascia that let a stalk of the fatty mass pass through; the fascial defect was closed with a suture (they show a figure).

At certain point, while taking potent drugs for pain as “Demerol” (it is meperidine, a potent opioid drug) because of constant incapacitating pain, she got depressed.

They do not inform of any histological findings.

They do not refer to other authors’ work. There are not any references.

Herniation of fat through lumbodorsal fascia as a cause of low back pain

Charles D. Bonner M.D. and S. Charles Kadson, M.D.

Boston

From the Cancer Research and Cancer Control Unit, Department of Surgery, the Department of Medicine and Gynecology, Tufts College Medical School. Boston Univeristy School of Medicine.

The authors start the article mentioning that they present this case report to illustrate the difficulties they encountered when trying to help a woman with a history of unexplained, severe and incapacitating pain.

They mention that the patient ended up treating her pain with strong opioids (meperidine).

The CASE HISTORY about herniation of fat through lumbodorsal fascia

An obese 67-year-old woman was admitted to hospital in July 1952. The chief complaint was “pain in the region of the left buttock radiating medially to the tip of the spine”. It was present for 4 months. The pain restricted her daily activities. She could sleep well at night.

No orthopedic lesion could be found to account for the complaints.

The patient was afraid to have a cancer. After full examination that ensured her she was free from cancer, she got better and was discharged from the hospital after 5 days with the diagnosis of “osteoarthritis”.

In September 1952, she was studied in another hospital. An X-ray examination revealed “osteoarthritic changes about the margins of the vertebral bodies”. She was treated with heat, aspirin, flat mattress and phenobarbital.

She was visited several times more. She underwent sigmoidoscopy, barium-enema, and intravenous pyelogram. She was also diagnosed with “rotatory scoliosis to the left” and “left lumbar facet reactive changes” apart from “osetoarthritis”.

In April 1953, she was visited again by low back pain with urinary frequency and urgency (she was repaired by a cystocele and rectocele).

She became more inactive and depressed. BECAUSE OF CONTINUOUS PAIN IN LEFT LUMBAR REGION, she took “Empirin” (codeine and aspirin) and “Demerol” (meperidine).

In September 1953, she was referred to the New England Hospital. She was depressed and cried intermittently. She was very definite in localizing her pain. She touched in one place with her finger and said that that was the pain.

During physical examination, the back was palpated. In the spot she showed, a FIRM TENDER MASS could be palpated deeply, and pressure on it reproduced the whole pain syndrome.

Infiltration of this area with 10 cc of 1% NOVOCAINE abolished the pain completely for several hours. She was then referred to the authors for therapy.

She underwent and operative exploration with general anesthetic of the left lumbar area.

While performing a TRANSVERSE SECTION of the subcuticular fascial layer of the left lumbar area, THERE APPEARED a PROTRUDING LOBULATED FAT MASS (6-8 cm). The mass was found protruding through a defect in the posterior sheath of the lumbodorsal fascia. The defect was in the plane of the oblique fascial layers and measured 3 cm long.

Through the midportion of the hernial defect a well-defined STALK passed from the lobulated fat pad above the lumbodorsal fascia to the fat overlying the sacroespinalis muscle.

The stalk was pulled up under moderate tension, clamped, transected and transfixed.

The defect in the fascia was closed with a single row of interrupted silk sutures.

Convalescence was uneventful and the patient kept free of pain as far as 6 months after operation.

Published in July 2018 by Marta Cañis Parera   

Reference:

• BONNER CD, KASDON SC. Herniation of fat through lumbodorsal fascia as a cause of low-back pain. N Engl J Med. 1954 Dec 30;251(27):1102-4. PubMed PMID: 13223963.