Paravertebral compartment syndrome after training causing severe back pain in an amateur rugby player: report of a rare case and review of the literature

Georg Mattiassich,Markus Leitinger,Heinrich Schubert,Eugen Trinka,Lorenz Larcher,Gottfried Wechselberger

doi:10.1186/1471-2474-14-259

Abstract

BackgroundAcute 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.Case presentationA 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.ConclusionsWe 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.

Highlights

Acute compartment syndrome (CS) of the paravertebral muscles without external trauma is rarely reported in literature
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
Based on the results of a cadaveric dissection and a clinical study of pressure measurements in healthy volunteers, the authors who presented that case reported that the paravertebral muscles were ensheathed in a fascial envelope, which is anatomically and physiologically similar to other muscle compartments known to be susceptible to CS

Summary

Conclusions

Based on the results of studies of peripheral CS, various pressures have been suggested as critical limits for surgical intervention. Styf and Lysell reported a patient with exercise-induced chronic back pain caused by chronic CS. In all reported cases of paravertebral CS, the main symptom was steadily increasing pain which started within 12 hours of exercise. T2-weighted MRI findings suggested paravertebral muscle edema. Most previously reported patients with lumbar paravertebral CS were managed by conservative treatment. Styf and Lysell reported that fasciotomy relieved the pain in a patient with chronic unilateral lumbar paravertebral CS [16]. Only 11 cases of acute paravertebral CS have been reported Three of these were treated with fasciotomy, resulting in full recovery. We experienced good results after performing surgical decompression in a patient with acute lumbar paravertebral CS after excessive training. All authors read and approved the final manuscript

Background