V.S. Tolkachov, V.V. Tolkachov (point of view)
Alternative names: hump on the back of the neck, dorsocervical fat pad, interscapular fat hump, Buffalo Hump, menopausal hump, local lipodystrophy, widow hump, etc.
Pic. 1 - Buffalo Hump
According to the widely accepted belief, Buffalo Hump is an excessive accumulation of dense adipose tissue in the area where the neck meets the top of the thoracic region of the spine. However, the condition of the spine (e.g. the presence of degenerative processes and the changing of its configuration) is not taken into the account.
Pic.2 - Аn excessive accumulation of dense adipose tissue in the cervical-thoracic region
In our opinion, there are two main components which should be distinguished in the mechanism of this pathology
1. Degenerative-dystrophic violations of the spine and surrounding tissue, mainly
in the cervical-thoracic region with the dislocated vertebras. As a result, a local
outward curvature (kyphoscoliosis) forms.
2. Localised collection of density adipose tissue.
These two components are the terms of the problem formation.
The problem area is hardly mentioned in the literature. At the same time, understanding of the pathology is important for the selection of the correct treatment tactics. To date, according to the prevailing notions about the disease, liposuction (removal of adipose tissue) is the most common procedure.
Based on the on the information above, the diagnosis can be formulated as follows: Vertebra-fat hump in area where the neck meets the top of the thoracic region of the spine or traditional Buffalo Hump. Displacement of the vertebras may cause headaches, unstable blood pressure, dizziness, limited movement of the neck and numbness in the arms.
Pic. 3 - Vertebra-fat hump in area where the neck meets the top of the thoracic region of the spine
The disposition of the vertebrae in the cervical-thoracic junction may contribute to headaches, unstable blood pressure, dizziness, limited mobility of the neck, and numbness of arms.
The Buffalo hump is slightly more often found in women. The appearance of the fat pouch on the revealed part of the spine is perceived by them as a general physical disorder and may cause depression. To cover the fatty hump, many women wear closed clothes.
Vertebral-fat hump (Buffalo hump) is commonly found in adults ranging from normal weight to obesity.
The basis for the formation of Buffalo hump may be several reasons:
- Long term use of certain medications e.g. steroid hormones, medications used in the treatment of HIV, etc.
- Due to a physical state disorder of a patient e.g. hormonal imbalance, adrenal gland disease, etc.
- Excessive accumulation of fat (results in obesity).
- Heredity also plays a part in it.
- In some cases, the cause of the hump can not be identified.
The exact cause or mechanism of Buffalo hump is not entirely clear. Lack of knowledge about the nature of the disease makes it difficult to cure.
Majority of the surgeons don’t take into account the changes in the configuration of the spine. The volume of the therapy is reduced to the liposuction only. However, this approach does not provide a radical cure, and after surgical treatment is administered, relapses are often recorded. Additionally, the operation itself can induce accumulation of adipose tissue in other areas of the body. Other side effects and complications of surgery include: postoperative scarring and irregularities on the surface of the skin, infections. Surgical treatment is advisable if there is a large adipose tissue collection.
Our experience shows that the treatment should start with the reposition of vertebrae in the problem area. When conducting Manual Therapy, it is important to take into account the structural features of the spine at the level of the lower-cervical and upper-thoracic (C6-T4). The mobility of the vertebrae at this level is significantly limited due to the presence of fixing joints between the transverse outgrowths of the vertebrae and rib arcs, thus Manual Therapy techniques applied by a specialist are important.
We have developed a Manual Therapy technique, which allows eliminating the intervertebral blocks to restore the physiological position of the vertebrae and improve the condition of the surrounding tissues. In severe cases, it is possible to significantly reduce manifestations of the Buffalo Hump. Therapeutic correction should be carried out throughout the vertebral column as a single spatial and functional system, in which the disposition of one department is compensated by changes in the other
Positive dynamics are observed after the first Manual Therapy procedures. After the correction of the spine, in the place of the BH,a density adipose - tissue hump has now become soft. Underweight people usually have an elastic skin-fat pouch left over.
The residual formation is removed by using a cocktail of drugs which dissolve fat cells in Aesthetic Medicine
Pic.4 - After the repositioning of the vertebrae in the problem area, the thick, fat pad becomes soft;
Pic.5 - Underweight people usually have an elastic skin-fat pouch left over.
In our practice, we use products, which have effective fat dissolving qualities and inject them into the skin-and-fat pouch that was left after the correction of the spine. Drugs are administered in subcutaneous fat by Mesotherapy or ionophoresis.
The outcome of Mesotherapy is a gradual dissolving of fat cells, caused by the components in the remedy. These products are then removed through the excretory organs. Furthermore, modern lipolytic agents have the ability to return the tone and skin elasticity while having no side effects. If it is necessary, supplementary medications are prescribed to improve the endocrine glands and gastrointestinal tract functions. Selection of drugs is individualised.
The duration of treatment depends on the size of the accumulated fatty tissue, the degree of degenerative changes in the cervical-thoracic spine, the presence of inflammation, and the comorbidity of the medical conditions. It could total from 1.5 to 2 months. Depending on the patient, the procedure can range from painless to low amounts of pain; it is well accepted and has no complications or side effects.
After Mesotherapy, some swelling and small bruises can appear, but they will disappear within 2-3 days. To prevent recurrence, a complex of therapeutic measures is advised to be re-administered. The earlier the treatment started the better the result.
Pic.6 – Re-alignment and Reduction of Buffalo Hump and correction of hyperlordosis of the lumbar spine through Implementing Manual Therapy and Aesthetic Medicine ( Manual-Aesthetic Medicine )
Based on the above, we recommend formulating the diagnosis as follows:vertebral- fat hump in the lower-cervical and upper thoracic part of the spine.
Treatment should be aimed at:
1) Correction of the spinal column with a primary effect on the C6-T4
2) Removal of the fat pad (Buffalo hump) where adipose tissue is accumulated using lipolytic cocktails or various medical devices (magnetophoresis, ionophoresis ect.)
Do not take this treatment if you suffer with any of the following:
- Serious disorders in the cardio-vascular system.
- Oncological illnesses.
- Infectious illnesses, HIV.
- Continuous intake of medications that provoke Buffalo Hump.
Pic. 7 Re-alignment and Reduction of Vertebral-Fat Hump (Buffalo Hump)
Pic. 8 Pre-Buffalo Hump
To further prove our point of view, we have supplied a photo of a young woman that has a disposition of the vertebrae between the lower neck and upper chest area of the spine. Currently, there are no signs of the adipose tissue development. This situation we called pre - lipodystrophy, or pre-Buffalo Hump.
The proposed therapeutic approach allows affecting some parts of pathogenetic chain and gives a good clinical and cosmetic result; it does not preclude the search for the cause of the problem (Buffalo Hump Factor) and it’s successful elimination.
The combined use of Manual Therapy and Aesthetic Medicine (Manual-Aesthetic Medicine) in many cases allows to successfully carry out correction treatment of the patient’s problematic figure without surgical procedures and with no complications.
David M. Aboulafia, M.D., and Denise Bundow, A.R.N.P. Buffalo Hump in a Patient with the Acquired Immunodeficiency Syndrome N Engl J Med 1998; 339:1297
Saint-Marc T, Touraine JL. Buffalo hump in HIV-1 infection. Lancet. 1998;352:319–320. doi: 10.1016/S0140-6736(05)60293-0
Lo JC, Mulligan K, Tai VW, Algren H, Schambelan M. `Buffalo hump’ in men with HIV-1 infection.Lancet 1998, 351: 867 –870.
Wajchenberg BL. Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. Endocr Rev2000; 21: 697–738.
Westerbacka J, Yki-Jarvinen H, Vehkavaara S, Hakkinen AM, Andrew R, Wake DJ, et al. Body fat distribution and cortisol metabolism in healthy men: enhanced 5 beta-reductase and lower cortisol/cortisone metabolite ratios in men with fatty liver. J Clin Endocrinol Metab 2003; 88: 4924–4931.
P. J. Piliero, M. Hubbard, J. King, and J. J. Faragon “Use of Ultrasonography-Assisted Liposuction for the Treatment of HIV-Associated Enlargement of the Dorsocervical Fat Pad” Clinical Infectious Diseases 2003;37:1374-1377 Albany Medical College, Albany, New York
Rodriguez de la Concepcion ML, Domingo JC, Domingo P, Giralt M, Villarroya F. Uncoupling protein 1 gene expression implicates brown adipocytes in highly active antiretroviral therapy-associated lipomatosis. AIDS. 2004;18:959–960.
Mallon PW, Wand H, Law M, Miller J, Cooper DA, Carr A. HIV Lipodystrophy Case Definition Study; Australian Lipodystrophy Prevalence Survey Investigators. Buffalo hump seen in HIV-associated lipodystrophy is associated with hyperinsulinemia but not dyslipidemia. J Acquir Immune Defic Syndr. 2005;38:156–162.
Palella FJ Jr, Chmiel JS, Riddler SA, Calhoun B, Dobs A, Visscher B, Kingsley L. A novel pattern of lipoaccumulation in HIV-infected men. JAMA. 2006;296:766–768. doi: 10.1001/jama.296.7.766.
Palacios R et al. Cervical lipomatosis in HIV-infected patients: a case control study. HIV Med 8: 17 – 21, 2007.
Additional pages:Intervertebral herniation (Hernia of intervertebral disk) Arthrosis deformans of the hip and knee joints (Gonarthrosis) Coxarthrosis
The following are problems my treatment can help with:
Manipulation is also possible on the elderly and on pregnant women.Dr. Vladimir Tolkachov. A man with anaesthetic in his hands...
Marty Mc Cool