Acute Exertional Lumbar Paraspinal Compartment Syndrome

Abstract

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.

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

“…Of these, thirteen papers described a single case and two described two cases, for a total of seventeen cases. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] However, upon closer inspection, it was discovered that a single case had been presented twice. 3,4 We therefore have presented here what we believe is only the 17 th case of acute lumbar paraspinal compartment syndrome currently published in the scientific literature (Table 1).…”

“…3,[5][6][7][8][9][10]13,14,17 Three treatment options were apparent in the literature: conservative management, consisting of aggressive fluid and electrolyte replacement and analgesia; hyperbaric oxygen added to conservative management and, as administered to our patient, surgical fasciotomy. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] There was no clear pattern in terms of when each treatment was administered, with one 67-year old male treated surgically despite a peak serum CPK of under 8,00015, and yet a 43-year old gentleman with a CPK peaking at over 162,000 treated conservatively6. In some instances, surgery was considered, but deferred when serum CPK and creatinine levels started to decline with initial conservative management alone.…”

“…[3][4][5][7][8][9][10]13,14,17 One of the remaining two under-40 cases was related to a gastric bypass procedure for morbid obesity, and the other secondary to substance abuse, specifically with synthetic cathinone (so-called 'bath salts'). 6,12 Conversely, none of the five older cases (over age 40) involved athletic endeavors, three cases occurring following aortic bypass procedures one secondary to synthetic cathinone abuse, and the single case involving a female secondary to direct trauma to her back. 6,11,12,15,16 Our patient had the acute onset of symptoms, having been asymptomatic, in terms of back pain, prior to participating in acute, strenuous athletic activities earlier the same day of his presentation to the emergency room.…”

“…6,12 Conversely, none of the five older cases (over age 40) involved athletic endeavors, three cases occurring following aortic bypass procedures one secondary to synthetic cathinone abuse, and the single case involving a female secondary to direct trauma to her back. 6,11,12,15,16 Our patient had the acute onset of symptoms, having been asymptomatic, in terms of back pain, prior to participating in acute, strenuous athletic activities earlier the same day of his presentation to the emergency room. This pattern too mirrors what has been reported in the literature, most reporting the onset of their severe back pain within 12 to at most 36 hours of a single precipitating event.…”

“…Since that publication, in four papers, an additional five cases of acute paraspinal compartment syndrome have been reported, in addition, our review identified an older (2008) case reported that was somehow neglected in the Nathan et al review. [3][4][5][6][7][8] In this paper, we first present our own case, and then re-analyze the essential characteristics of the now seventeen cases that have been reported in the scientific literature. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] …”