Another name for back mice is sacroiliac lipomatosis. This is a short article from Dr Raymond from Pennsylvania (USA). He presented his results at the meeting of the Guthrie Clinic Alumni Association in June 1960. Previously, in 1952, (Raymond 1952) he presented a short editorial of what he thought was a “new clinical entity” by then. In this second article he already refers to Copeman and Ackerman’s work from 1944 (Personal note: in 1952 he probably did not know about all the previous work published by other authors).

He insists that sacroiliac lipomatosis may be a minor malady, but one that can give much suffering.

He states that he prefers the name sacroiliac lipomatosis, since the cases are often bilateral and over the sacroiliac region.

He just has 2 references: Copeman and Ackerman (1944), and Dittrich (1950).

He presents the results in 30 operated patients that underwent surgical removal from the sacroiliac nodules.

He does not make ANY HYPOTHESIS of the possible etiopathogenic causes.

He makes certain emphasis that some of the patients also presented headache or sciatica as an accompanying symptom. But he doesn’t make any reflection about the possible fisiopathological explanation. He just states that the patient improved after the nodule excision.

Sacroiliac lipomatosis

Malcolm L. Raymond MD

“Whose hath despised the day of small things?”

Dr Raymond wants to call attention to a “minor malady” that may often cause severe pain and disability.

Raymond mentions Copeman and Ackerman’s work (1944) and Dittrich (1950). And, despite Professor F. J. Kottke from the University of Minnesota states that the incidence is quite rare, Raymond found the nodules fairly common, possible due to the fact that there were many “stout females” in the area.

Raymond published an editorial in the Pennsylvania Medical Journal in 1952, to focus attention on the condition. Also because UNNECESSARY pelvic or spinal surgery may be performed if the condition is NOT RECOGNIZED.

Raymond explains that the condition has several names: fibrositis of the back, lumbar lipomatosis and herniated fat nodules. Raymond likes the name SACRO-ILIAC LIPOMATOSIS because, in the majority of cases, they found there were nodules in the sacro-iliac joints.

They suggest exploring every woman with backache around the sacroiliac area. There may be the presence of discrete and firm masses of varying size. They are often movable beneath the examining fingers. Copeman classified them in 3 categories: nonpedunculated, pedunculated, and foraminal.

IF THE CONDITION CAUSES SYMPTOMS, PRESSURE ON THE NODULE WILL CAUSE THE PAIN OF WHICH THE PATIENT COMPLAINS.

Histologically, it is found that the nodules consist of LIPOMA-LIKE MASSES that have pushed through the fascia and have irritated the nerve filaments.

Local anesthetic around the nodule can give temporary or permanent relief. If necessary, the nodule is excised by surgery.

They make a TRANSVERSE SECTION under general anesthetic.

ON INCISING THE FASCIA, the nodule PROMPTLY SHOWS UP into the incision proving the tension over it.

The fascia and fat are closed and apposed in layers with absorbable sutures, and the skin with silk. They apply an icecap over the dressing. They use a drain for 5 to 7 days.

Sacroiliac lipomatosis cases

-One patient had intractable sciatica, which was completely relieved.

-One case was unable to sleep on her back. It was completely relieved.

-One case had daily headaches that have not recurred in over two months after surgical removal.

-One case had coexistence of pathologies: she required a hysterectomy for uterine pathology with partial relief, later they excised the nodule with complete relief.

-Another case they noticed firstly an asymptomatic nodule, which later became painful, and was then removed.

They had a series of 34 cases; they operated 30 with complete relief. 13 unilateral and 21 bilateral. Only one case was permanently relieved by injection.

Published in October 2018 By Marta Cañis Parera

References

RAYMOND ML. Sacro-iliac lipomatosis. Guthrie Clin Bull. 1960 Oct;30:14-6. PubMed PMID: 13739963.