Lumbar Paraspinal Compartment Syndrome Research Articles

Case Study: Acute Lumbar Paraspinal Compartment Syndrome in an Austere Military Environment.

The incidence of compartment syndrome of the lumbar paraspinal muscles is exceedingly rare. Approximately 24 hours following a high-intensity kettlebell swing workout, a 33-year-old Sailor presented to the medical department on board a forward deployed Wasp-class amphibious assault ship with increasing discomfort in his middle and lower back, and evidence of rhabdomyolysis. Discomfort quickly turned to unrelenting pain coupled with dorsal paresthesias and rigidity in the paraspinal muscles. He was taken emergently to the operating room, where his paraspinal muscles were released via fasciotomy. As a result of limited resources aboard the deployed ship, a negative pressure wound dressing was fashioned using the supplies available aboard the ship. Following 3 days of the negative pressure wound therapy, muscle bulging decreased substantially, and the skin was closed. After 4 weeks of physical therapy, he returned to full duty.

Acute Lumbar Paraspinal Compartment Syndrome after a Tug of War: A Case Report and Review of the Literature

Compartment syndrome of the upper and the lower extremities is a well-known entity in emergency medicine and traumatology. However, compartment syndrome of the paraspinal musculature is a very rare cause of acute back pain and may be missed at presentation despite its clinical importance. Therefore, we present a case of paraspinal compartment syndrome embedded in an overview of the actual literature. A 21- year-old woman presented with acute back pain refractory to analgesia with opiates after a tug of war match. A CT-scan of the abdomen demonstrated paraspinal swelling and an MRI ruled out intra-spinal pathologies. A compartment measurement yielded a pressure of 135mmHg. Even though conservative treatment attempts are often described, an emergency fasciotomy was carried out. Further rehabilitation was uneventful. Nevertheless, the timing of fasciotomy in the paraspinal region is under discussion, especially due to very rare experiences. Even if surgery is delayed by more than 24 hours following symptom onset, favourable postoperative outcomes have been observed.

A Case of Acute Traumatic Lumbar Paraspinal Compartment Syndrome

BackgroundCompartment syndrome is a life-threatening complication of traumatic injury, most commonly, direct trauma. Back pain is a common cause of visits to the emergency department (ED) and often is treated without imaging or diagnostic testing. Lumbar paraspinal compartment syndrome is a rare cause of acute back pain. Case ReportA 43-year-old woman presented to the ED after direct trauma to the lower back. Laboratory studies revealed rhabdomyolysis and acute kidney injury, with examination findings and imaging consistent with lumbar paraspinal compartment syndrome. She was taken to the operating room for emergent fasciotomy. Why Should an Emergency Physician Be Aware of This?It is the job of the emergency physician to identify the red flags in history and physical examination that warrant further diagnostic testing. Early diagnosis and surgical consultation is the key in avoiding morbidity and achieving good outcomes in all forms of compartment syndrome.

Acute lumbar paraspinal compartment syndrome: a systematic review.

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.

Acute Lumbar Paraspinal Compartment Syndrome after Weightlifting: A Case Report

Acute Lumbar Paraspinal Compartment Syndrome after Weightlifting: A Case Report

Compartment syndrome of lumbar paraspinal musculature after percutaneous pedicle screw fixation

Background:Compartment syndromes have been reported in nearly every anatomical area of the extremities. Similarly, in the lumbar spine, there is a risk of a compartment syndrome following either direct or indirect injury to the paraspinal muscles. In this study, we present a case of lumbar paraspinal compartment syndrome after percutaneous pedicle screw fixation for a spine fracture.Case Description:A 27-year-old obese female sustained a fall and an L1 fracture. Her neurological examination was normal. She underwent a minimally invasive percutaneous posterior pedicle screw fixation from T12 to L2 to stabilize the L1 fracture. Postoperatively, the patient developed hypoesthesia in the back, and sterile serous wound discharge. Because of the persistent discharge, an open debridement was performed that revealed multiple cavities within the necrotic avascular paraspinal musculature. Once these were completely excised, the wounds healed uneventfully.Conclusion:Patients undergoing minimally invasive posterior thoracolumbar (TL) pedicle screw fixation can develop a compartment syndrome involving the TL paraspinal musculature. This case highlights the need for early consideration of a compartment syndrome when patients develop persistent sterile discharge after spine surgery. In this case, urgent decompression prevented any long-term sequelae.

Acute Lumbar Paraspinal Compartment Syndrome after Weightlifting: A Case Report

Acute Lumbar Paraspinal Compartment Syndrome after Weightlifting: A Case Report

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

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).

Excruciating Low Back Pain After Strenuous Exertion: Beware of Lumbar Paraspinal Compartment Syndrome

BackgroundLow back pain is extremely common and usually a minor self-limiting condition. Rarely, however, it is a harbinger of serious medical illness. Paraspinal compartment syndrome is a rare condition, but its timely recognition is important to allow adequate treatment. Case ReportA 16-year-old boy presented to the Emergency Department (ED) with severe low back pain, necessitating intravenous opioids. Laboratory results showed severe rhabdomyolysis. Magnetic resonance imaging of the lumbar spine showed diffuse edema and swelling in the paraspinal muscles. Aggressive fluid therapy was started but despite narcotic analgesia the pain persisted and creatine kinase (CK) levels increased. Compartment pressures of the erector spinae were found to be increased. The decision was made to proceed with bilateral paraspinal fasciotomies. Postoperatively, the patient noted immediate pain relief with rapid decrease of CK level. The patient is pain free and resumed running and swimming 3 months after admission in the ED. Why Should an Emergency Physician Be Aware of This?Although paraspinal compartment syndrome is a rare condition, its recognition is of paramount importance to allow adequate surgical treatment, preventing muscle necrosis. Although back pain most often has a benign course, a careful history and physical examination in patients presenting with low back pain allows determination of “red flags.” Mandatory further diagnostic tests can identify underlying serious illness.

Comment on Nathan et al.: lumbar paraspinal compartment syndrome

1. S-T Nathan and his colleagues state that a PubMed search was conducted with the title query, lumbar paraspinal compartment syndrome, which found ten articles. However, only six articles were found besides Nathan’s paper [1] when we performed the same search on September 19, 2012. 2. Was the search for articles thorough? First, two electronic databases (the PubMed and OVID Medical databases) were searched by the authors. But a PubMed, Embase, CINAHL, and Cochrane database search was done using the search strategy recommended by the Cochrane Back Review Group. Second, S-T Nathan and his colleagues only searched medical subject headings, keywords and the title “lumbar paraspinal compartment syndrome”. Based on the above considerations, we think that the search for articles was not thorough. A search strategy report plays an important role in systematic reviews. Sampson et al. [2] considered that critical appraisal is impossible if the search strategy is not thoroughly reported in systematic review. 3. One author selected high yield abstracts and obtained full articles in Nathan’s review. According to the Cochrane Handbook for Systematic Reviews of Interventions [3], in order to reduce the bias, it is most important that the final selection and extraction of studies into the review are undertaken by more than one author. 4. The conclusion of the article showed that the basic trend is to surgically decompress the compartment to avoid long-term functional sequelae in other muscular compartments of the body. We suggest nonoperative treatment options are the first line of management for compartment syndrome. Diebal et al. [4] also suggested that an effective nonoperative management approach could eliminate these potential postsurgical complications for compartment syndrome.

Lumbar paraspinal compartment syndrome

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.

Acute Exertional Lumbar Paraspinal Compartment Syndrome

A case report and review of the literature. To report a rare case of paraspinal compartment syndrome that presented a diagnostic challenge. Paraspinal compartment syndrome is a rare condition defined as increased pressure within a closed fibro-osseous space, resulting in reduced blood flow and tissue perfusion in that space. The reduced perfusion causes ischemic pain and irreversible damage to the tissues of the compartment if unrecognized or left untreated. A 20-year-old African-American man presented with 2 days of new-onset progressive back pain after repetitive lifting of 235 lbs in a deadlift exercise. The patient had significantly tender lumbar paraspinal muscles, was unable rise from a supine position, and had severe pain with attempted active rolling or sitting. Findings of supine radiographs were normal. Findings of initial laboratory investigations were consistent with rhabdomyolysis and acute kidney injury. Despite aggressive hydration and narcotic analgesia, the patient's creatinine kinase and myoglobin continued to rise and his pain continued to worsen. Computed tomography of the spine revealed enlarged paraspinal musculature and decreased enhancement bilaterally. Gadolinium-enhanced magnetic resonance imaging of the spine showed increased T2 signal and paraspinal muscle edema with areas of decreased contrast uptake, consistent with ischemia and necrosis. Compartment pressures measured 78 mm Hg on the left and 26 mm Hg on the right. Because hydration and analgesia had failed, the patient was taken urgently to the operating room for bilateral paraspinal fasciotomies with delayed closure. His symptoms and rhabdomyolysis then resolved during the next 2 days. The diagnostic challenge presented by this case, especially considering the rarity of paraspinal compartment syndrome, indicates the need for a high index of suspicion in the appropriate setting.

Chronic lumbar paraspinal compartment syndrome

A 25-year-old male weightlifter felt increasing intractable low back pain during training but denied any acute injury. The physical examination, blood parameters, radiographs and MRI were unremarkable. He had been treated non-operatively by various means, with only temporary relief. The pressures in the lumbar paraspinal compartment were abnormally high and he was treated by surgical decompression. This gave rapid relief, he returned to training, and one year later the pain had not recurred.

Low Back Pain After Nonspinal Surgery: The Characteristics of Presumed Lumbar Paraspinal Compartment Syndrome

PM&RVolume 1, Issue 4 p. 383-388 Case Presentation Low Back Pain After Nonspinal Surgery: The Characteristics of Presumed Lumbar Paraspinal Compartment Syndrome Andrew J. Haig MD, Corresponding Author Andrew J. Haig MD andyhaig@umich.edu Department of Physical Medicine and Rehabilitation, The University of Michigan, 325 E Eisenhower, Ann Arbor, MI 48108Disclosure: nothing to discloseAddress correspondence to: A.J.H.Search for more papers by this authorAnne G. Hartigan MD, Anne G. Hartigan MD Department of Physical Medicine and Rehabilitation, The University of Michigan, Ann Arbor, MIDisclosure: nothing to discloseSearch for more papers by this authorDouglas Quint MD, Douglas Quint MD Department of Radiology, The University of Michigan, Ann Arbor, MIDisclosure: nothing to discloseSearch for more papers by this author Andrew J. Haig MD, Corresponding Author Andrew J. Haig MD andyhaig@umich.edu Department of Physical Medicine and Rehabilitation, The University of Michigan, 325 E Eisenhower, Ann Arbor, MI 48108Disclosure: nothing to discloseAddress correspondence to: A.J.H.Search for more papers by this authorAnne G. Hartigan MD, Anne G. Hartigan MD Department of Physical Medicine and Rehabilitation, The University of Michigan, Ann Arbor, MIDisclosure: nothing to discloseSearch for more papers by this authorDouglas Quint MD, Douglas Quint MD Department of Radiology, The University of Michigan, Ann Arbor, MIDisclosure: nothing to discloseSearch for more papers by this author First published: 09 April 2009 https://doi.org/10.1016/j.pmrj.2008.12.011Citations: 9 Disclosure Key can be found on the Table of Contents and at www.pmrjournal.org Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume1, Issue4April 2009Pages 383-388 This article also appears in:Sports Medicine RelatedInformation

Cardiac arrest caused by reperfusion injury after lumbar paraspinal compartment syndrome.

Cardiac arrest caused by reperfusion injury after lumbar paraspinal compartment syndrome.

Acute lumbar paraspinal compartment syndrome. A case report.

Department of Orthopaedics and Rehabilitation, McClure Musculoskeletal Research Center, Burlington 05405.

Lumbar paraspinal compartment syndrome—A case report with physiologic and anatomic studies : Carr D. Gilbertson L. Frymoyer J. Krag M. Pope M. Spine 1985; 10: 816–820

Lumbar paraspinal compartment syndrome—A case report with physiologic and anatomic studies : Carr D. Gilbertson L. Frymoyer J. Krag M. Pope M. Spine 1985; 10: 816–820

Lumbar Paraspinal Compartment Syndrome

A 24-year-old man presented with severe low-back pain and paraspinal muscle spasm after exertion. Elevation in temperature, white blood cell count, serum muscle enzymes, and urine myoglobin, as well as computer tomographic evidence of paraspinal muscle edema and necrosis, were present. No etiology could be documented, and the possibility of an acute exertional compartment syndrome was entertained. Subsequently, cadaveric dis-sections indicated that the erector spinae muscles are contained within a well-developed fascial sheath. Continuous slit catheter pressure measurements within this compartment in eight healthy male subjects were subsequently carried out. These indicated a physiologic behavior similar to other known compartments for which compartment syndromes have been described. Variation in intracompartmental pressure occurred as a function of body posture, erector spinae isometric contraction, and active intra-abdominal pressurization. We suggest this patient had a paraspinal compartment syndrome and have described pressure characteristics of this compartment in normal men.