Acute lumbar paraspinal compartment syndrome: a systematic review

Deadlift-Induced Paraspinal Compartment Syndrome: A Case Report

Paraspinal compartment syndrome is a rare and potentially life-threatening condition. Diagnosis and treatment are often delayed due to a broad differential for back pain, from musculoskeletal to abdominal etiologies. Diagnosis is made with difficulty through clinical picture, laboratory values representative of rhabdomyolysis, advanced imaging, and compartment pressure measurements. Unfortunately, this diagnosis is late; therefore, risks of significant morbidity increase. The mainstay of treatment is emergent fasciotomy of the paraspinal muscles and medical management of rhabdomyolysis. The majority of patients return to baseline functional strength and full range of motion after early treatment. We present a case of severe bilateral paraspinal compartment syndrome that resulted in excisional debridement of necrotic muscle, acute kidney injury, and ileus.

Acute lumbar paraspinal compartment syndrome after radical cystectomy

Lumbar paraspinal compartment syndrome (LPCS) is a rare diagnosis, seen in patients chronically after repeated lumbar trauma or acutely in a postoperative setting. Only a dozen cases are documented worldwide, and to date no clinical guidelines exist for the diagnosis nor the treatment.We describe the case of a 44-year-old man with excruciating lower back pain following a radical cystectomy. The postoperative laboratory values were compatible with acute rhabdomyolysis. The lumbar spine MRI showed necrosis of lumbosacral paraspinal muscles, making the diagnosis of acute LPCS. After seeking advice from different specialists, the conservative approach was chosen with combined pain treatment and physiotherapy. The patient is currently still disabled for some tasks and needs chronic pain medication.

Atraumatic Acute Paraspinal Compartment Syndrome in a Patient With McArdle's Disease

A 60-year-old male presented to the emergency room with complaints of back pain overlying the left lumbar area and ipsilateral thigh numbness. The left erector spinae musculature was rigid, tense, and painful to palpation. An elevated serum creatine kinase was identified, and a computed tomography scan showed evidence of left paraspinal musculature congestion. Past medical/surgical history was significant for McArdle's disease and bilateral forearm fasciotomies. The patient underwent lumbosacral fasciotomy with no obvious myonecrosis. The patient was discharged home after skin closure and has since been seen in clinic with no residual pain or change in baseline functional status. This case may represent the first reported atraumatic exertional lumbar compartment syndrome in a patient with McArdle's disease. Prompt operative intervention was effective in this case of acute atraumatic paraspinal compartment syndrome and resulted in an excellent functional outcome.

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).

Low-velocity, civilian firearm extremity injuries-review and update for radiologists

Firearm injuries are a preventable epidemic in the USA. Extremities are commonly affected in gunshot injuries. Such injuries may be complex with concomitant osseous, soft tissue, and neurovascular components. The maximum wounding potential of a projectile is determined by its kinetic energy and the proportion of the kinetic energy that is transmitted to the target. Accurate assessment of ballistic injuries is dependent on utilizing the principles of wound ballistics, accurate bullet count, and ballistic trajectory analysis. The goals of this article are to review wound ballistics and the imaging evaluation of extremity civilian firearm injuries in the adult population, with emphasis on ballistic trajectory analysis, specific ballistic fracture patterns, and diffuse, secondary soft tissue ballistic injuries.

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.

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.