Lower limb compartment syndrome following lumbar discectomy in the knee-chest position

Abstract

We report on two cases of compartment syndrome following lumbar discectomy in the knee-chest position. This complication has only been described once since 1953. Seven cases of compartment syndrome following other surgical procedures were found in the literature. Any increases in tissue pressure of a muscle compartment exceeding 35-40 mmHg over a longer period of time can result in this complication for example, too tight cast, space-occupying intrafascial bleeding, or postischemic swelling. The diagnosis is purely clinical and is based on the typical combination of extremely painful edema with rapid onset of sensory loss and subsequent motor deficits. The muscle necrosis leads to myoglobinaemia and myoglobinuria, recognizable by brown urine. The therapy consists of urgent fasciotomy of swollen compartments without skin suture. The prognosis is highly dependent on the time of the surgical decompression: within 6 hours serious deficits are avoidable; after 24 hours irreversible necrosis of muscle occurs. It seems that the possibility of a compartment syndrome is a specific, but a rare risk of a prolonged knee-chest position.

Crush syndrome presenting three days after injury

“…This syndrome has also been reported in patients during prolonged general anaesthesia. 1 Patients may also develop this syndrome with an unresolved or untreated compartment syndrome. Direct trauma is thought to cause cell death through mechanical disruption, 4 followed by myonecrosis and ischemic injury.…”

Rhabdomyolysis following renal autotransplantation

“…Perioperative rhabdomyolysis may be caused by malignant hyperthermia, preoperative intensive muscular exercise, compression of musculature leading to muscle ischemia, dermatomyositis, one of several enzyme deficiencies and familial periodic paralysis. [5][6][7][8][9][10] Muscular ischemia and malignant hyperthermia etiologies were deemed most likely in our patient because of the abrupt nature and timing of his rhabdomyolysis. Many cases of surgical positioning-related rhabdomyolysis have been reported.…”

“…Many cases of surgical positioning-related rhabdomyolysis have been reported. 5,8,11,12 Although this complication is most often reported for patients who undergo procedures while in a lithotomy position, it has also been reported for patients who undergo procedures while in a supine position, or a hyperlordodic posture, or for patients who simply undergo long-lasting surgery. 6,12 Therefore, our patient's weight, the duration of his surgery and his positioning could potentially have lead to pressure ischemia.…”

Bilateral Leg Compartment Syndrome Complicating Prolonged Spine Surgery in the Kneeling Position

“…Under anaesthesia, postural insults may occur that would normally not be tolerated in awaken patients [1]. CS has been described in spinal surgery [2][3][4][5][6][7][8][9].…”