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Exercise-Induced Paraspinal Muscle Rhabdomyolysis with Seconary Compartment Syndrome: A Case Report

Authors:
1229
Copyrights © 2019 The Korean Society of Radiology
Case Report J Korean Soc Radiol 2019;80(6):1229-1234
https://doi.org/10.3348/jksr.2019.80.6.1229
pISSN 1738-2637 / eISSN 2288-2928
󾖻󾖴󾖴
󾖴
󾖴󾖴
󾖾󾖴󾖴󾖴
󼐣󻅈󾖴󽐳󾖴󻦋󻹌󽋋󾖴󼨈󼬃󼙫󼑳󺭫󼓇󾖴󽐐󻢧󺭫󼒤󽋣󼜌󺩫
󼓣󼦗󼕰󼓧󾖴󺫛󽏼󼜌󽐳󺫟󼜌󻖯󾖴󻩣󺩏
 



 



󽗉

 

Index terms
INTRODUCTION
󽦁
  


 
󾋸󾋹
󽦁
Received
Revised
Accepted
*Corresponding author

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ORCID iDs
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jksronline.org
1230
Lumbar Paraspinal Compartment Syndrome
CASE REPORT
󾋹󾋽
    󾋸󾋹󽦁
󽦁




󾋽󾋷 
󾋺󾋷󾋷󾋷󾋹󾋿󾋾󾋹 
 󾋾󾋻󾋹󾋿󾋷󾋹󾋽󾋹󾋷󾋷
󾋹󾋷󾋷󾋷󾋸󾋻󾋷󾋹󾋾󾋸󾋽󾋻󾋺
󾋷󾋺󾋾󾋸󾋾󾋸󾋷󾋻󾋸
 󾋸󾋷󾋺󾋼󾋷 󾋻󾋷󾋷󾋷
󾋸󾋷󾋷󾋷󾋷
󾋸󾋽󾋹󾋽󾋷󾌀󾌀
 
󾋸󽦀
 󽦁 󾋸
󽦀󾋹󾋸
󾋸
󽦁


󾋸
 

 󽦂 󾋿󾋷 
󽦁
  
󾋹󾋺󾋼
󾋽󾌀󾌀󾋷󾋼󾋽󾋺󾋸󾋾󾋺 
󾋹󾋸󾋼󾋹󾋾
󾋻󾋷󾋷󾋻󾋾
󽦀󽦂

DISCUSSION
󽦁  

 󾋽
https://doi.org/10.3348/jksr.2019.80.6.1229 1231
J Korean Soc Radiol 2019;80(6):1229-1234



󽦁󾋺

 

 󾋹󾋷 
  
󾋹

󽦁
  
󽦀
󽦁
Fig. 1.󽗉 

A.
󽗉
B.  󽗉

C.󽗈

D. 

E.



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ED
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jksronline.org
1232
Lumbar Paraspinal Compartment Syndrome
 
󽦀󾋹


󾋹󽦁
  󾋻
󽦀󽦂


 󽦂 
󾋹
 󾋹 󽦀
󽦀
󽦀󽦁
󽦂

󾋼
  
󾋸󾋹

󽦀

󽦁


 󾋽
 
󽦁
 󽦁 

󾋹 
  󾋾 

󽦁 


󾋸󽦁
   

󾋿
󾌀󽦁󽦁

󾋹  󾋸
https://doi.org/10.3348/jksr.2019.80.6.1229 1233
J Korean Soc Radiol 2019;80(6):1229-1234



󽦀


Author Contributions
 
  


Con󽗊icts of Interest
󽦂
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Lumbar Paraspinal Compartment Syndrome
󼐣󻅈󾖴󽐳󾖴󻦋󻹌󽋋󾖴󼨈󼬃󼙫󼑳󺭫󼓇󾖴󽐐󻢧󺭫󼒤󽋣󼜌󺩫
󼓣󼦗󼕰󼓧󾖴󺫛󽏼󼜌󽐳󺫟󾖾󾖴󼜌󻖯󾖴󻩣󺩏
󼗟󻾜󻢧󾖴󾗆󾖴󼓣󺮟󼔛*󾖴󾗆󾖴󼜳󼐘󼙯󾖴󾗆󾖴󺮯󺮟󽏇󾖴󾗆󾖴󼓣󺨬󼒯󾖴󾗆󾖴󼁛󼔛󼦛󾖴󾗆󾖴󽏘󻁯󽍳󾖴󾗆󾖴󺮯󽎧󺭏
󼞻󼺻󻺧󼠫󾋊󼷀󼺻󼨣󼠫󺼣󼡿󾋊󺺓󽞴󼫄󽟫󺺗󼡧󾋊󺼰󼉘󾋊󼞻󽋜󼡿󾋊󽡻󽙿󼫧󾋊󼙱󼡧󾋊󼟷󼢟󼢛󻐋󼢛󻎻󾋊󼐓󽚃󾋊󼐇󼷛󾋊󽞃
󻔀󼢛󻆿󾋊󼌿󼍇󾋊󽝠󼡧󾋊󼚤󻱣󼡿󾋊󽚐󻷸󼫄󼡣󻦃󾋊󼈄󺽗󺶳󾋊󻕃󻐋󼫨󼤸󼤨󼢟󾋊󼞟󼇨󾋊󼛭󼢛󾋊󻵃󼈄󽚃󾋊󼞻󼺻󻺧󼠫󾋊󼷀
󼺻󼨣󼠫󺼣󼡿󾋊󺺓󽞴󼫄󽟫󺺗󼡧󾋊󻘃󻱣󺶳󾋊󻸛󺸇󻔿󼛯󻐋󼤧󼢷󻘋󼡧󾋊󻘘󾋊󺼣󼡈󼡿󾋊󺴼󽚃󾋊󼟛󻔀󾋊󼢛󽟫󾋊󽟈󻱟󺼣󼡜
󽚛󼫄󼛷󾋊󼡿󽚛󾋊󻵃󼈄󽚃󾋊󺺓󽞴󼫄󽟫󺺗󾋊󼫄󻥧󼛷󼉃󾋊󼚸󼯤󾋊󼷀󼺻󼨣󼠫󺼣󼡿󾋊󻽫󻐧󾋹󺴼󼦗󼜨󼇨󼛷󼉃󼡿󾋊󺸇󼐇
󽝟󾋊󺴼󻓫󻴶󾋊󻺯󺼇󼢣󽚃󾋊󼦗󼜨󾋊󼫄󺴼󼡿󼢷󺽗󺸜󻮬󼜨󼇨󾋊󼊳󺷓󼡫󾋊󻸛󺸇󽙿󺸇󼢷󾋊󽚃󻐋󾋒󻸟󾋊󼫄󻥧󼛷󼉃󻎻󾋊󼦗
󼜨󾋊󼫄󺴼󾋊󼐃󾋊󺼣󼡈󾋊󻇛󾋊󽜯󺸧󾋊󼦗󼜨󼢛󾋊󻸛󼢛󼫧󾋊󼙱󻎻󾋊󼊳󺷓󼢛󾋊󺺓󽞴󼫄󽟫󺺗󼡿󾋊󼫫󻐏󼛷󾋊󻓫󼟧󼢛󾋊󻔿󼛯󻐋
인제대학교 서울백병원 1영상의학과, 2신경외과
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Article
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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 case report of a 23-year-old male college student with lumbar paraspinal compartment syndrome who was treated conservatively. Methods: We report a case of a 23-year-old male college student with lumbar paraspinal compartment syndrome who was treated conservatively. We repeatedly checked his physical examination, laboratory tests, lumbar compartment pressures, and magnetic resonance imaging, and surgical teams were readily prepared to operate should the patient's condition worsen. To prevent complications of rhabdomyolysis, hydration and alkalization were performed. We followed him up to 2 years after discharge. Result: Although the temporal changes on MRI up to the 1-year point, the patient continued to have no symptoms. Conclusions: Conservative therapy can be recommended if rhabdomyolysis is under control.
Article
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The 17th case of acute lumbar paraspinal compartment syndrome in the scientific/medical literature was presented in this study. We then review all 17 cases for demographic and clinical characteristics, in particular in terms of how they influence ultimate outcomes. All but one case occurred in a male, and most patients were less than age 40 (71%). Symptoms typically were precipitated by some athletic activity (59%), other causes were surgery (n = 4), drug abuse (n = 2), and direct trauma (n =1). Peak CPK values ranged from 5000 to 350,000 U/L. Ten patients ultimately achieved or were presumed to achieve full recovery, six had persistent low back pain several months later and one remained in renal failure. The only predictor of final outcome was the treatment given, with six of seven who underwent surgical fasciotomy and both patients administered hyperbaric oxygen experiencing full recovery, versus just two of seven treated conservatively (p = 0.03).
Article
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Acute compartment syndrome (CS) of the paravertebral muscles without external trauma is rarely reported in literature. Not all of clinical symptoms for CS are applicable to the paravertebral region. A 30-year-old amateur rugby player was suffering from increasing back pain following exertional training specially targeting back muscles. He presented with hardly treatable pain of the lumbar spine, dysaesthesia of the left paravertebral lumbar region as well as elevated muscle enzymes. Magnetic resonance imaging (MRI) showed an edema of the paravertebral muscles. Compartment pressure measurement revealed increased values of 47 mmHg on the left side. Seventy-two hours after onset of back pain a fasciotomy of the superficial thoracolumbar fascia was performed. Immediately postoperatively the clinical condition improved and enzyme levels significantly decreased. The patient started with light training exercises 3 weeks after the operation. We present a rare case of an exercise-induced compartment syndrome of the paravertebral muscles and set it in the context of existing literature comparing various treatment options and outcomes. Where there is evidence of paravertebral compartment syndrome we recommend immediate fasciotomy to prevent rhabdomyolysis and further consequential diseases.
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Objective: To validate the diagnostic performance of an in-scanner exercise-based magnetic resonance imaging (MRI) examination used to screen for chronic exertional compartment syndrome (CECS). Final clinical impression and intracompartmental needle manometry (INM) served as the reference standards. Materials and methods: Consecutive patients, referred by a sports medicine physician or orthopedic surgeon, underwent the MRI examination for lower extremity pain over the past 4 years and 9 months. Utilizing a diagnostic T2-weighted intensity ratio threshold of 1.54, established by a prior cohort of patients, sensitivity, specificity, predictive value, and diagnostic odds ratio were calculated for the anterior compartments. The means of the T2-weighted intensity ratios were compared using the Wilcoxon rank sum test. Results: A total of 79 patients were identified, and 76 met the inclusion criteria and were evaluated. Of these, 23 met clinical diagnostic criteria. Sensitivity and specificity were 96% (95% CI: 79-99%) and 87% (95% CI: 75-94%) using the established threshold of 1.54. T2-weighted intensity ratio provided excellent discrimination with a concordance statistic of 0.96 (95% CI: 0.91-1.00). In the subset of 36 patients with INM results, 23 patients met criteria for CECS, although only 19 patients met both INM and clinical criteria. The sensitivity and specificity of the MRI examination relative to INM results were 87% (95%: 70-96%) and 62% (95% CI: 36-82%) respectively. Conclusion: In-scanner exercise-based MRI demonstrated reliability and reproducibility as a non-invasive screening test for CECS, thus reducing the need for invasive INM.
Article
While still a rare entity, acute lumbar paraspinal compartment syndrome has an increasing incidence. Similar to other compartment syndromes, acute lumbar paraspinal compartment syndrome is defined by raised pressure within a closed fibro-osseous space, limiting tissue perfusion within that space. The resultant tissue ischaemia presents as acute pain, and if left untreated, it may result in permanent tissue damage. A literature search of ‘paraspinal compartment syndrome’ revealed 21 articles. The details from a case encountered by the authors are also included. A common data set was extracted, focusing on demographics, aetiology, clinical features, management and outcomes. There are 23 reported cases of acute compartment syndrome. These are typically caused by weight-lifting exercises, but may also result from other exercises, direct trauma or non-spinal surgery. Pain, tenderness and paraspinal paraesthesia are key clinical findings. Serum creatine kinase, magnetic resonance imaging and intracompartment pressure measurement confirm the diagnosis. Half of the reported cases have been managed with surgical fasciotomy, and these patients have all had good outcomes relative to those managed with conservative measures with or without hyperbaric oxygen therapy. These good outcomes were despite significant delays to operative intervention. The diagnostic uncertainty and subsequent delay to fasciotomy result from the rarity of this disease entity, and a high level of suspicion is recommended in the appropriate setting. This is particularly true in light of the current popularity of extreme weight lifting in non-professional athletes. Operative intervention is strongly recommended in all cases based on the available evidence.
Article
Acute compartment syndrome in an extremity is a limb-threatening surgical emergency. However, magnetic resonance imaging (MRI) has rarely been performed to establish the diagnosis of this condition. We report 3 cases of compartment syndrome of the lower extremities, one in the acute stage and two in chronic stages. All three patients were involved traffic accidents with unilateral lower limb fractures. No significant past medical history or other causes of myopathy was present in any of the three cases. The patient with an acute compartment syndrome was diagnosed with the condition based on clinical information. MRI performed one-month following fasciotomy for suspected myonecrosis revealed muscular swelling, edema, interstitial hemorrhage, and myonecrosis. Muscular necrosis was confirmed by subsequent surgical debridement. The other two subjects with chronic conditions had histories of lower limb fractures. One suffered from ankle deformity and the other, erythematous painful swelling in the leg. MRI demonstrated localized fibrosis and muscular atrophy in both cases as well as superimposed cellulitis in the second case. The myopathies in both cases were confined in the leg corresponding to previous fracture. The myopathies are contributed to neglected compartment syndrome without prompt fasciotomy 2 and 20 years ago, respectively.
Article
The purpose of this study was to systematically review the available evidence on lumbar paraspinal compartment syndrome with specific reference to patient demographics, aetiology, types, diagnosis, clinical features, and treatment. This was an Institutional Review Board-exempt study performed at a Level 1 trauma center. A PubMed search was conducted with the title query: lumbar paraspinal compartment syndrome. Eleven articles met our search criteria. Three of the patients with acute paraspinal compartmental syndrome treated with fasciotomy had a full recovery and were able to resume skiing after four months. The aetiology of the onset of lumbar paraspinal compartment syndrome is broadly divided into acute and chronic. Lumbar paraspinal compartment syndrome is one of the causes of back pain with diagnostic clinical features which should be considered in the differential diagnosis of a patient with low back pain. Prospective multicentre trials may provide the surgeon with more insight into the diagnosis and management of lumbar paraspinal compartment syndrome.
Article
The aim of this study was to evaluate the use of MR imaging for diagnosis and therapy management of compartment syndromes. In total, 15 patients (5 with an imminent compartment syndrome and 10 with manifest compartment syndrome) underwent MR imaging with a variety of pulse sequences including fat suppression, magnetization transfer imaging, and intravenous gadopentetate dimeglumine (Gd-DTPA) administration. Early and late follow-up MR images were obtained. Manifest compartment syndromes showed swollen compartments with loss of normal muscle architecture on T1-weighted spin-echo images. T2-weighted spin-echo and magnetization transfer imaging showed bright areas, which enhanced after Gd-DTPA. Early follow-up showed changes in enhancement patterns; late follow-up showed fibrosis and cystic and fatty degenerations of the affected compartments. MR imaging can help make the diagnosis of a manifest compartment syndrome in clinically ambiguous cases. It points out the affected compartments and allows the surgeon to selectively split the fascial spaces.