This article published in 2015 focuses on a new treatment for the “sacroiliac fascial lipocele” also known as back mice to treat a neglected cause of lumbosacral pain. They present a case study that was treated by percutaneous endoscopy.

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Sacroiliac fascial lipocele could be a neglected cause of lumbosacral pain: case study of percutaneous endoscopic treatment.

Yang J. S., Chu L., Hao D. J., Zhen Y. Y., Deng Z. L.

Pain Physician. 2015 Mar-Apr; 18(2): E267-9.

PubMed PMID: 25794233.

From Department of Spinal Surgery, Hong-Hui Hospital Medical College of Xi’an Jiaotong University, Xi’an 710054, China.

The authors start with an illustrative CASE REPORT of lumbosacral pain

A 50-year-old woman who complained of lumbosacral pain radiated to buttock for 6 months.

By physical examination they found a round nodule above the right medial iliac crest. The complaining pain would be replicated by pressing the nodule and eliminated by a diagnostic nerve block of lidocaine.

Ultrasonography showed a subcutaneous lipoid echo area just above the right side of the upper edge of the medial iliac crest.

There was NO POSITIVE finding in the lumbar magnetic resonance imaging (MRI).

Although the patient went through 3 months of physical therapy and therapeutic nerve block with betamethasone and lidocaine, the efficiency was ONLY TEMPORARY and unsatisfactory.

A percutaneous ENDOSCOPIC DECOMPRESSION was performed under local anesthesia.

Technique: they explained the technique by which they excised the squirted fat tissue and bleeding was coagulated by a bipolar radiofrequency precisely. They evaluated the preservation of the neural branch during the whole surgery.

Patient outcome: the patient’s pain decreased from 7 to 2 just after operation, the pain disappeared after 4 days and there was no pain in 1 year follow-up.

Yang et al. comment that SFL could be a NEGLECTED cause of lumbosacral pain

 Physicians COMMONLY encounter lumbosacral pain and it is usually associated with intervertebral disc structures, facet joints or surrounding muscles. But in the absence of disturbances by the aforementioned structures the pain is often diagnosed as intractable.

They proposed the new name SACROILIAC FASCIAL LIPOCELE (SFL), also named pannicular hernia. They stated that SFL could be a NEGLECTED CAUSE of lumbosacral pain.

They mentioned that it was first reported by Ficarra (1952), when they used surgery for severe cases. They advocated that in the era of the MINIMALLY invasive surgery, percutanous endoscopic operation could be an option and bridge the gap between conservative and traditional open surgery.

According to anatomy, in the reported case the branches of the gluteal nerve may be the pain source.

Possible fisiopathological explanation from Yang et al. the lumbosacral pain caused by the lipoceles

-The lumbosacral region is richly endowed with adipose tissue.

-The lumbosacral fascia above the upper edge of the medial iliac crest is relatively weak.

-With severe bending or violent contraction the inner pressure of deep tissue is extruded from the foramen.

-Besides edema, bleeding, torsion even incarceration of the lipocele may occur, the neighboring neural branches are also irritated by the inflammatory medium.

-Depending on the size of the hernia hole and its content, there are individual differences of the severity of the symptoms.

-In suspected SFL, superficial ultrasonography and the nerve block may be useful for locating the primary source of pain.

-SFL can be misdiagnosed as lipoma or lumbar disc herniation. Nevertheless, lipoma is usually asymptomatic.

 

Published in May 2018 By Marta Cañis Parera  

References

• Yang J. S., Chu L., Hao D. J., Zhen Y. Y., Deng Z. L. Sacroiliac fascial lipocele could be a neglected cause of lumbosacral pain: case study of percutaneous endoscopic treatment. Pain Physician. 2015 Mar-Apr; 18(2): E267-9. PubMed PMID: 25794233.
• Ficarra 1952 Ficarra B. J., McLaughlin W. J. Low back pain due to pannicular hernias; report of a case. J Am Med Assoc. 1952 Nov 1; 150(9): 855. PubMed PMID: 12990314.
• Knight 1954 Knight E. C. Sacro-iliac lipoma versus panicular hernia. J Iowa State Med Soc. 1954 Feb; 44(2): 62-3. PubMed PMID: 13118264.
• Kanan 1959 KANAN E. J. [Hernias of the sacral fascia]. Dia Med. 1959 Aug; 31(Spec No): 32-4. Spanish. PubMed PMID: 14404267.