Acute erector spinae compartment syndrome: case report and review of diagnostic criteria

Lumbar Paraspinal Compartment Syndrome: Case Report and Critical Evaluation of the Literature

BACKGROUND

Lumbar compartment syndrome is a recognized clinical phenomenon, despite receiving less attention as a clinical entity. Given its rarity, the definitive presentation, diagnosis, and management strategies are not completely agreed upon.

MATERIALS AND METHODS

A literature search on PubMed of all case reports of lumbar paraspinal compartment syndromes was conducted. All case reports and reviews were analyzed for patient demographic data, presentation, diagnostic evaluation, treatment, and clinical follow-up.

RESULTS

A total of 37 cases of lumbar compartment syndrome were identified. Overall, 91.9% occurred in men with an average age of 30.9 years. Weightlifting (n=18, 48.6%) and physical exertion (n=7, 18.9%) accounted for the majority of presentations. In all, 37.8% of cases occurred unilaterally. Creatinine kinase, aspartate aminotransferase, and alanine aminotransferase were notably elevated. Compartment pressure was elevated with an average of 91.8 mm Hg (SD: 44.8 mm Hg). Twenty-two cases were treated operatively (59.5%) and 15 (40.5%) were treated nonoperatively. In total, 19/20 (95.0%) of cases treated operatively reported either resolution of pain or return to baseline activities without limitation, compared with 1/11 (9.1%) treated nonoperatively. This difference between the operative and nonoperative cohort was statistically significant ( P <0.0001).

CONCLUSIONS

Lumbar paraspinal compartment syndrome is a rare, but well-documented clinical entity. In all, 67.5% of cases occurred after weightlifting or physical exertion. Overall, 40.5% of cases in the literature were treated nonoperatively. Per our analysis, there is a clinically and statistically significant difference in cases treated operatively versus nonoperatively (95.0% vs. 9.1%, P <0.0001).

Minimally Invasive Percutaneous Fasciotomy in Lumbar Paraspinal Compartment Syndrome: A Case Report and Review of Literature

CASE

Lumbar paraspinal compartment syndrome (LPCS) is a rare but potentially catastrophic pathology caused by increased intracompartmental pressures leading to potential ischemic necrosis of muscle, local denervation, and complications of rhabdomyolysis. A combination of unique clinical history and examination findings, laboratory findings, and radiologic imaging help in diagnosis.

CONCLUSION

Early detection and intervention with minimally invasive percutaneous fasciotomy can minimize local soft tissue trauma while providing extensive fascial release with good clinical outcomes. Radiographic follow-up in this case suggests that the muscle at risk in LPCS can be spared with early surgical intervention.

Substance-Related Found-Down Compartment Syndrome: A Systematic Review

OBJECTIVE

To characterize the patient population with substance-related found-down extremity compartment syndrome (FDECS) and report on their treatment and outcome.

DATA SOURCE

This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Articles in English language were identified by searching 3 online databases, EMBASE, PubMed Publisher, and Cochrane Central, in September 2019.

STUDY SELECTION

Studies involving substance-related FDECS were included. Exclusion criteria were as follows: patient age <18 years, not original studies, no full text available, technical reports, traumatic acute extremity compartment syndrome, chronic exertional compartment syndrome, and vascular acute extremity compartment syndrome.

DATA EXTRACTION

There were 61 studies included with 166 cases of FDECS. Two investigators screened and extracted data independently according to a standardized template. Disagreements were addressed by an attempt to reach a consensus, and involvement of a third reviewer. Studies were quality assessed with "Quality Assessment tool for Case Series Studies."

DATA SYNTHESIS

Descriptive statistics were reported using Excel.

CONCLUSION

Substance-related FDECS is often occurring in young adults. Data from this review found that most of the patients were already diagnosed with substance use disorders and/or psychiatric disorders. There should be a high index of suspicion of FDECS in patients presenting after prolonged immobilization.

LEVEL OF EVIDENCE

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Postoperative lumbar paraspinal compartment syndrome

Lower lumbar paraspinal muscles constitute a compartment as they are surrounded by distinct fascial and bony boundaries. Lumbar paraspinal compartment syndrome is a rare entity, often caused by intense exercise, but also can be a postoperative complication. We present a 60-year-old man with low back pain, numbness in the left lower back and radicular pain in the left lower extremity, which started after a surgery that involved prolonged positioning on the left side 7 years before, and persisted to the day of evaluation. There was an immediate transient rise in the creatine kinase after surgery. Electromyography showed a left lower lumbar-sacral plexopathy and a lumbar spine MRI revealed fatty infiltration of the lower lumbar-sacral paraspinal muscles. The emergence of radicular lower limb pain was likely due to the compression of the proximal portion of lumbar-sacral plexus during the acute stage of rhabdomyolysis.

Acute Lumbar Paraspinal Compartment Syndrome After Strenuous Exercise: A Case Report

CASE

Acute lumbar paraspinal compartment syndrome (APCS) is rare. This case report describes the clinical presentation and magnetic resonance imaging (MRI) findings of APCS in a young man after strenuous weight training. The patient underwent surgical decompression of the paraspinal muscles with fasciotomy 4 days after presentation and made a complete functional recovery at the 3-month follow-up postsurgery.

CONCLUSION

This case report highlights the importance of MRI in facilitating the diagnosis of APCS and demonstrates that fasciotomy, even if delayed, can result in complete functional recovery. This supports current understanding that surgical fascial decompression is the preferred treatment over conservative measures for this condition.

Acute Paraspinal Compartment Syndrome After Deadlifting: A Case Report

CASE

A 27-year-old African man was admitted with acute right-sided loin pain that had started 4 hours after deadlifting. Renal colic was suspected, but clinical and radiological examination revealed no pathology of the urinary system. Further investigation revealed rhabdomyolysis. The back pain worsened with flexion, and both loins were hard on palpation 24 hours later. High intracompartmental pressures confirmed acute paraspinal compartment syndrome.

CONCLUSIONS

We performed fasciotomy of the back muscles 28 hours after the onset of pain. Eighteen months after surgery, the patient no longer performed deadlifts but returned to pain-free exercise.

Compartment syndrome: Neuromuscular complications and electrodiagnosis

Compartment syndrome (CS) is a treatable condition characterized by elevated intracompartmental pressure and may be acute or chronic in nature. Sustained elevated compartment pressure can lead to ischemia and necrosis of muscle as well as injury to peripheral nerves, creating a deficit that may be neuropathic, myopathic, or mixed. While electrodiagnostic assessments are of limited utility in the diagnosis of acute/traumatic CS, they can assist with prognosticating return of function after surgical fasciotomy or in clarifying the injury pattern in cases in which a traumatic injury results in subsequent neuromuscular deficits. They can also be used to rule out conditions that mimic chronic exertional CS. During electrodiagnostic assessment, clinicians should be aware of patterns associated with muscle fibrosis vs denervation and use this information to assist with prognostication and appropriate counseling for patients regarding any interventional or adaptive treatments that may help restore function.

An Acute Paraspinal Compartment Syndrome: Anatomic Description of the Compartment and Surgical Technique

An acute paraspinal compartment syndrome (CS) is a rare condition and is only described in a few case reports. In our spine surgery department, a 16-year-old boy with severe low back pain due to a lumbar paraspinal CS. was treated with a paraspinal fasciotomy. After this case, we performed a cadaver study to determinate the compartment. The objective of this paper is to give a description of the anatomic lumbar paraspinal compartment and our surgical technique, a transmuscular paraspinal approach described by Wiltse and colleagues. The lumbar CS is most often seen in the lateral compartment where the erector spinae muscle, subdivided into the iliocostalis and the longissimus, is encased within a clear fascia. Lumbar paraspinal CS is a rare complication but should always be recognized. A thorough knowledge of the anatomy helps you to understand the clinical signs and start a correct treatment.

Excruciating Low Back Pain After Strenuous Exertion: Beware of Lumbar Paraspinal Compartment Syndrome

BACKGROUND

Low back pain is extremely common and usually a minor self-limiting condition. Rarely, however, it is a harbinger of serious medical illness. Paraspinal compartment syndrome is a rare condition, but its timely recognition is important to allow adequate treatment.

CASE REPORT

A 16-year-old boy presented to the Emergency Department (ED) with severe low back pain, necessitating intravenous opioids. Laboratory results showed severe rhabdomyolysis. Magnetic resonance imaging of the lumbar spine showed diffuse edema and swelling in the paraspinal muscles. Aggressive fluid therapy was started but despite narcotic analgesia the pain persisted and creatine kinase (CK) levels increased. Compartment pressures of the erector spinae were found to be increased. The decision was made to proceed with bilateral paraspinal fasciotomies. Postoperatively, the patient noted immediate pain relief with rapid decrease of CK level. The patient is pain free and resumed running and swimming 3 months after admission in the ED. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although paraspinal compartment syndrome is a rare condition, its recognition is of paramount importance to allow adequate surgical treatment, preventing muscle necrosis. Although back pain most often has a benign course, a careful history and physical examination in patients presenting with low back pain allows determination of "red flags." Mandatory further diagnostic tests can identify underlying serious illness.