Acute exertional paraspinal compartment syndrome

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

“…[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). However, it is the 6th case reported in the last three years (since 2010), and the 5th since the last review by Nathan et al in 2012.…”

“…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.…”

“…Among the twelve cases under age 40, ten (83%) had the onset of their symptoms after intense athletic activity, that activity being weight-lifting in six cases, downhill skiing in three and surfboarding in a single case. [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.…”

“…In several cases, serum CPK levels continued to rise despite conservative management that included aggressive fluid replacement; in every case, these dramatic post-treatment-initiation related increases (e.g., from 19,000 to 60,800 U/L3) in CPK occurred in a weight-lifter. 3,5,7,8 Categorizing patients into those under versus over age 40, eight of eleven (73%) younger patients ultimately had CPK levels over 50,000 U/L, versus just one of four (25%) over age forty; and the single person > 40 years old who had a CPK peak >50,000 was one whose rhabdomyolysis and consequent compartment syndrome were related to the drug cathinone; this patient's CPK peaked at 162,4956. Categorizing patients into athletes, post-operative patients, drug users, and the single case of direct trauma, both drug abusers had CPK peaks > 100,000 (mean = 256,000 U/L).…”

“…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] …”