Lumbar Paraspinal Compartment Syndrome

Abstract

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).

Paralumbar compartment syndrome, a rare sequela of deadlifting: a case report and review of current literature

“…To date, there are no level 1 studies or strong recommendations for the treatment of paralumbar compartment syndrome. According to a recent systematic review, paralumbar compartment syndrome is common after patients participated in some sort of strenuous exercise, specifically high-intensity deadlifting—almost 50% of all case reports [ 2 ]. Patients diagnosed with paralumbar compartment syndrome appeared to present with similar symptoms, including low back pain with a focus of subjective decreased sensation over the lumbosacral region.…”

“…These patients tend to be admitted for rhabdomyolysis or acute kidney injury and were initially treated with IV fluids, urine alkalization, and IV narcotic pain medication, with escalating narcotic requirements over time. Magnetic resonance imaging studies were obtained at some point during the patients’ hospital stay, which shows a characteristic ‘extensive edema in the paraspinal musculature’ [ 2 ]. In light of these symptoms and findings, it is imperative for physicians to recognize the possibility of paralumbar compartment syndrome as a differential and promptly engage in consulting orthopedic surgery.…”

“…Ilyas et al recently published a systematic review comparing outcomes of the reported case reports of paraspinal compartment syndrome and found that despite the variable follow-up timing for these patients, most patients returned to pre-operative function with operative treatment [ 2 ]. One common theme found, including in this case report, that the patient felt immediate pain relief post-operatively.…”

“…One common theme found, including in this case report, that the patient felt immediate pain relief post-operatively. It was noted in this systematic review that patients who were not treated operatively experienced mild intermittent back pain associated with exertion post-operatively [ 2 ]. This could be devastating in patients who are very physically active.…”

Compartment syndrome – a complex and insidious medical problem

“…In addition to the lower extremity, which is the most common site where ACS is experienced, symptoms can also affect other locations. Cases have been described of patients who developed ACS after injuries to the feet, upper extremities, buttocks, trunk wall, back muscles or pelvis [11][12][13][14]. In children, most often fractures of the humerus and forearm bones lead to ACS syndrome, following which ACS localizes precisely in the upper limb in this age group.…”