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Enhanced MRI in the coronal plane on day 9 showed a cystic lesion in right multifidus muscle (arrow)
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Background:
Since in all studies of conservative treatment of lumbar compartment syndrome the follow-up duration was less than 6 months, it is difficult to draw firm conclusions.
Purpose:
To report a patient with lumbar paraspinal compartment syndrome who was treated conservatively over a follow-up period of 2 years.
Study design:
This is a ca...
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Rationale:
The incidence exercise-induced rhabdomyolysis is increasing in the healthy general population. Rhabdomyolysis can lead to the life-threatening systemic complications of acute kidney injury (AKI), compartment syndrome, and disseminated intravascular coagulopathy.
Patient concerns:
A 21-year-old man had bilateral lower limb pain and sor...
BACKGROUND Rhabdomyolysis is a syndrome characterized by muscle necrosis and secretion of intracellular muscle components into the blood circulation. Acute compartment syndrome is a potential complication of severe rhabdomyolysis. CASE REPORT We report 3 cases of compartment syndrome-related peripheral neuropathy in alcoholic individuals with rhabd...
Citations
... The lag time in diagnosis ultimately changed the treatment for some patients. Some non-operative case reports note that the timing and "clinical and laboratory improvement" of the patient led to treating that particular patient conservatively without operative intervention [9,10]. The majority of cases treated operatively had 'good' results with minimal issues in the limited postop follow-ups reported. ...
Background
Compartment syndrome is a well-known phenomenon that is most commonly reported in the extremities. However, paralumbar compartment syndrome is rarely described in available literature. The authors present a case of paralumbar compartment syndrome after high intensity deadlifting.
Case presentation
53-year-old male who presented with progressively worsening low back pain and paresthesias one day after high-intensity deadlifting. Laboratory testing found the patient to be in rhabdomyolysis; he was admitted for intravenous fluid resuscitation and pain control. Orthopedics was consulted, and Magnetic Resonance Imaging revealed significant paravertebral edema and loss of muscle striation. Given the patient’s lack of improvement with intravenous and oral pain control, clinical and radiographic findings, there was significant concern for acute paralumbar compartment syndrome. The patient subsequently underwent urgent fasciotomy of bilateral paralumbar musculature with delayed closure.
Conclusion
Given the paucity of literature on paralumbar compartment syndrome, the authors’ goal is to promote awareness of the diagnosis, as it should be included in the differential diagnosis of intractable back pain after high exertional exercise. The current literature suggests that operative cases of paralumbar compartment syndromes have a higher rate of return to pre-operative function compared to those treated non-operatively. This case report further supports this notion. The authors recommend further study into this phenomenon, given its potential to result in persistent chronic exertional pain and irreversible tissue damage.
... Nevertheless, the literature describes an increased recovery time and overall poor outcome with conservative treatment compared with surgical treatment. But no clear treatment recommendation can be given [5,8,13,14,[16][17][18]. Moreover, fasciotomy is associated with good outcomes in all reported cases, even with a significant delay from the time of symptom onset (up to 7 days) [5,8,14]. ...
Compartment syndrome of the upper and the lower extremities is a well-known entity in emergency medicine and traumatology. However, compartment syndrome of the paraspinal musculature is a very rare cause of acute back pain and may be missed at presentation despite its clinical importance. Therefore, we present a case of paraspinal compartment syndrome embedded in an overview of the actual literature. A 21- year-old woman presented with acute back pain refractory to analgesia with opiates after a tug of war match. A CT-scan of the abdomen demonstrated paraspinal swelling and an MRI ruled out intra-spinal pathologies. A compartment measurement yielded a pressure of 135mmHg. Even though conservative treatment attempts are often described, an emergency fasciotomy was carried out. Further rehabilitation was uneventful. Nevertheless, the timing of fasciotomy in the paraspinal region is under discussion, especially due to very rare experiences. Even if surgery is delayed by more than 24 hours following symptom onset, favourable postoperative outcomes have been observed.
... Fibrosis, calcification, and muscular atrophy can be seen as a sequel in the chronic phase. Some authors consider the decreased uptake of gadolinium as a sign of necrosis, which suggests irreversible damage and demands emergent surgical intervention (8), whereas other authors have suggested observing if the rhabdomyolysis is in control (9). The MRI findings of our case showed no definite complications of infarction, hemorrhages, or liquefactive necrosis that may be seen as bright signal intensities on a T2-and high or low signal intensity on a T1-weighted image. ...
Introduction
This review of case series and case reports explores conservative management strategies for paraspinal compartment syndrome (PCS), a rare clinical condition. Extremity compartment syndrome has been shown to be managed most effectively with emergent surgical release of the fascial compartment. Given the rarity of PCS and the paucity of research in the literature, some authors have suggested the possibility of conservative treatment. There has been no study to date that has specifically investigated the cases of non-operative management of PCS.
Materials and Methods
There are 16 case reports in the literature with 22 cases of PCS treated conservatively. The authors reviewed these cases, specifically viewing the clinical courses, why the decision was made to manage conservatively, and the reported outcomes.
Results
The etiology of PCS varied, with weightlifting being the primary cause in 11 out of 22 cases, followed by strenuous sporting events and postsurgical complications. All patients in this review were male, aged between 18 and 61 years old. Acute presentations exhibited severe back pain, rigid paraspinal musculature, and subjective paraspinal paresthesias. Magnetic Resonance Imaging findings of the spine revealed profound bilateral symmetric intramuscular edema. Among the cases, 8 explicitly reported a return to normal function, while 8 continued to experience symptoms related to the initial injury. Nine cases chose conservative measures primarily because of delayed presentation, seven instances reported successful outcomes with conservative measures; one case cited concerns about infection risk.
Discussion
The probability of underreporting related to PCS may result in a substantial number of cases being omitted from medical literature. Pathologically, PCS is characterized by increased intra-compartmental pressure, triggering rhabdomyolysis due to significant soft tissue damage. Emergent surgical intervention is the treatment of choice for any compartment syndrome; however, conservative management of these cases has shown satisfactory clinical outcomes. Hyperbaric oxygen therapy emerges as a potential adjunctive treatment to enhance tissue viability, though its efficacy and accessibility warrant further investigation in the context of PCS management.
Conclusion
Early recognition and treatment of PCS are critical in preventing chronic pain and permanent complications. Given the limitations identified in non-operative management, further research is imperative to optimize treatment strategies.
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).
