1963 Sedwitz and Thomas – Hernia Adiposa (A Cause of Low Back Pain)

Notes on the article about hernia adiposa and low back pain: 

Hernia Adiposa – A Cause of Low Back pain

Lee Sedwitz, M.D. and B.D. Thomas, M.D.

Zebulon, US

It is a small article about 20 patients with hernia adiposa that underwent surgical removal from their tender nodules in low back related to long history of unknown low back pain. The nodules were considered fatty hernias. They all had good outcome.

They have 4 pictures of the operating technique:

They described HERNIATION OF SUBFASCIAL FAT as the displacement of fat from a deep stratum to a more superficial one.

They just refer to Copeman and Herz’s previous work. Sedwitz and Thomas refer that Herz and Copeman had studied the nodules that form these hernias.

The term fibrositis was also used to describe them, since originally they thought that they were caused by excessive fibrous tissue.

Their study

-They studied 20 patients that referred low back pain of UNDETERMINED CAUSE.

-They proceeded with surgery on the patients that just received TEMPORARY relief from local infiltration with anesthetic and prednisolone. They operated on 20 patients.

-Many of the patients had been treated with various treatments for years, without relief. Even one patient had been operated on for herniation of nucleus pulposus without benefit.

-Physical examination showed nodules in the lower back, some were tender and other weren’t. The tender ones were the ones considered as the cause of low back pain.

Operative technique: The incision through the skin and superficial fat shows the herniation of the fat, the displaced fat is QUITE WELL DEFINED. Further infiltration is necessary to dissect from the underlying fascia. While dissecting, the area of vascularization and innervation of this fat is usually visualized. Dissection is carried out until the opening in the deep fascia is encountered. The deep fascial opening is closed. Haemostasia is done. They leave a rubber drainage for 48 hours.

Sedwitz and Thomas’ results

Some patients obtained SYMPTOMATIC relief at operation or immediately thereafter. Several had residual pain at the operative site for several weeks.

While operating, as the sensory nerves are divided, many patients stated that the pain elicited is quite similar to the one suffered previously.

One case relapsed after heavy lifting with a new adipose hernia; he got better after second surgery.

The histological analysis showed FIBROSIS of surface and septal tissue.

All the 20 patients were able to resume normal activity within 10 to 14 days after surgery.

Published in June 2018 By Marta Cañis Parera   ORCID iD icon

References:

  • SEDWITZ JL, THOMAS BD. HERNIA ADIPOSA — A CAUSE OF LOW BACK PAIN. N C Med J. 1963 Oct;24:473-5. PubMed PMID: 14053539
  • HERZ R. Herniation of subfascial fat as a cause of low back pain; report of 37 cases treated surgically. Ann Rheum Dis. 1946 Dec;5(6):201-3. PubMed PMID: 20242353
  • Copeman, W.S.C. and Ackerman, W. Fibrositis of the back (1944) . Quart.J.Med. 13,37.