Acute traumatic thoracolumbar paraspinal compartment syndrome: case report

Abstract

<jats:p>Although compartment syndrome can occur in any compartment in the body, it rarely occurs in the paraspinal musculature and has therefore only been reported in a few case reports. Despite its rare occurrence, acute paraspinal compartment syndrome has been shown to occur secondary to reperfusion injury and traumatic and atraumatic causes. Diagnosis can be based on clinical examination findings, MRI or CT studies, or through direct measurement of intramuscular pressures. Conservative management should only be used in the setting of chronic presentation. Operative decompression via fasciotomy in cases of acute presentation may improve the patient’s symptoms and outcomes. When treating acute paraspinal compartment syndrome via surgical decompression, an important aspect is the anatomical consideration. Although grouped under one name, each paraspinal muscle is enclosed within its own fascial compartment, all of which must be addressed to achieve an adequate decompression. The authors present the case of a 43-year-old female patient who presented to the emergency department with increasing low-back and flank pain after a fall. Associated sensory deficits in a cutaneous distribution combined with imaging and clinical findings contributed to the diagnosis of acute traumatic paraspinal compartment syndrome. The authors discuss this case and describe their surgical technique for managing acute paraspinal compartment syndrome.</jats:p>

Postoperative lumbar paraspinal compartment syndrome

“…The favourable outcome when defined as complete recovery or mild residual symptoms was reported in only 6 of 14 of the conservatively treated patients, whereas another 6 patients, including our patient, had significant chronic low back pain when followed-up for 2 months to 8 years after the incident (table 1). Optimal surgery timelines have not been established with regard to lumbar paraspinal compartment syndrome given the rarity of this condition 13 ; decompression fasciotomies have been done 2-3 days after the onset of symptoms with good long-term outcomes. 8 11 23 Figure 1 Sagittal T1-weighted image (A) and axial T2-weighted image (B) demonstrate adipose infiltration of the lumbar-sacral paraspinal muscles (large arrow), intact fascial boundaries of the lumbar paraspinal compartment (arrowheads) and proximity of the affected paraspinal muscles to the very proximal part of lumbar-sacral plexus, that is, ventral rami of the nerve roots (small arrow).…”

Acute exertional compartment syndrome of the lumbar paraspinal muscles in a weightlifter. A case report

“…Furthermore, there are characteristic findings of CS on advanced imaging . On CT enlargement of the paraspinal muscles is noted, representing the increased levels of fluid present in the compartment [7] . This swelling is also noted on MRI, with an additional finding of increased signal intensity on T2 weighted images [7] .…”

“…On CT enlargement of the paraspinal muscles is noted, representing the increased levels of fluid present in the compartment [7] . This swelling is also noted on MRI, with an additional finding of increased signal intensity on T2 weighted images [7] . Gadolinium contrast can also be used to highlight the damage in the paraspinal musculature but should be used sparingly in patients with kidney injury [6] .…”

“…Patients treated with surgery reported good functionality and little to no residual sequalae [ 2 , 5 ]. In cases of acute paraspinal CS treated conservatively, patients typically went on to recover and return to activity within 4–6 months, but had chronic back pain with exertional activities [ 5 , 7 ].…”

“…Unlike CS of the lower extremity, optimal timing of paraspinal fasciotomy has not been explored in the literature. Lower extremity CS fasciotomies should ideally be performed within 6 h of diagnosis of CS, but ultimately no more than 12 h [ 7 , 8 ]. Our patient underwent bilateral paraspinal fasciotomy upon transfer to our facility.…”