Acute lumbar paraspinal compartment syndrome: a case report and detailed literature review

Abstract

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).

Acute traumatic thoracolumbar paraspinal compartment syndrome: case report

“…In our review of the literature concerning acute paraspinal compartment syndrome, the majority of cases were caused by exercise or had surgery-related causes (i.e., reperfusion injury). 1,4,6,8,10,14,15 Sava et al reported the only case of paraspinal compartment syndrome secondary to trauma. Similar to our patient, their case involved a female patient of the same age who had had no spine-related fractures.…”

“…In a review performed by Alfaraj et al, the majority of acute paraspinal compartment syndromes were in men and in patients under the age of 40 years. 1 The review revealed that most cases of paraspinal compartment syndrome were due to exercise, followed by non-spine surgery (such as aortic bypass or gastric bypass), drug abuse, and trauma (direct injury to paraspinal muscles). 1 Alfaraj et al also provided a classification for paraspinal compartment syndrome, with type I being acute with 3 subtypes (A, atraumatic; B, direct trauma; and C, non-spine surgery) and type II being chronic exertional.…”

“…1 The review revealed that most cases of paraspinal compartment syndrome were due to exercise, followed by non-spine surgery (such as aortic bypass or gastric bypass), drug abuse, and trauma (direct injury to paraspinal muscles). 1 Alfaraj et al also provided a classification for paraspinal compartment syndrome, with type I being acute with 3 subtypes (A, atraumatic; B, direct trauma; and C, non-spine surgery) and type II being chronic exertional. 1 No specific patient demographics that might influence presentation and response to different treatment options have been identified in previous studies.…”

“…1 Alfaraj et al also provided a classification for paraspinal compartment syndrome, with type I being acute with 3 subtypes (A, atraumatic; B, direct trauma; and C, non-spine surgery) and type II being chronic exertional. 1 No specific patient demographics that might influence presentation and response to different treatment options have been identified in previous studies.…”

“…4 In some cases, MRI was used secondarily to further assess the musculature due to negative CT findings and a patient's continued or worsening symptoms. 1,8 In a review by Nathan et al, MRI was used in several reports as the initial imaging modality. 10 Our patient had abdominal CT scanning performed as the initial imaging modality due to the flank pain; the study showed the enlargement of paraspinal musculature.…”