Case report: A rare case of acute lumbar paraspinal compartment syndrome in a military trainee

Image by: Airman st Class Janelle Patio

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Author: Conner Murphy, MSIV, Ivan Yue, MSIV, and Vivek Abraham, MSIV
Uniformed Services University School of Medicine
AAEM/RSA Publications and Social Media
Committee

INTRODUCTION
Acute lumbar paraspinal compartment syndrome is a rare injury, occurring primarily in male patients and often related to overhead weight lifting activities.[1] It has also been reported following skiing, surfing, blunt trauma, and as the result of reperfusion injury following abdominal aortic procedures.[2] The syndrome occurs when the enclosed fibro-osseous space of the lumbar paraspinal compartment increases in pressure beyond perfusion pressure, leading to ischemia, intractable pain and eventually tissue necrosis if left untreated.[1] Patients generally present with intense acute pain after exercise, physical exam revealing swollen and tense lumbar paraspinal muscles, and laboratory abnormalities including high creatine kinase levels and myoglobinuria, often appearing like or in conjunction with rhabdomyolysis.[2] Muscle tissue may remain viable for up to four hours without irreversible damage, while eight hours of ischemia has been known to cause irreversible necrosis.[3] Early recognition and orthopedic consultation for surgical management decreases prolonged suffering and neurovascular compromise, allowing resolution of rhabdomyolysis and pain, as well as return to baseline athletic activity.[4] In this case report, we present a case of acute lumbar compartment syndrome in a young athletic male in the context of intense military training.

Recovering from Leg Day: Rhabdomyolysis in the Emergency Department

Image Credit: Image from James Heilman, MD

This post was peer reviewed.
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Author: Jeffrey Chen, MSIII
University of California San Francisco

Case: A previously healthy 18-year-old male comes in to the pediatric emergency department complaining of severe bilateral soreness and weakness of quadriceps and dark tea-colored urine for 1 day. Yesterday at the gym he performed heavy squats and lunges consecutively for one hour and drank minimal water. He denies recent URI symptoms or trauma.

Vitals are within normal limits. On exam, the patient’s anterior thighs are hard, swollen, and tender to touch and have limited passive and active range of motion. Sensation and capillary refill are normal in the distal lower extremities. Serum creatine kinase levels are 41,000; other labs include: BUN 14, Creatinine 0.73, Potassium 4.4, Phosphorus 3.8, Calcium 8.8. Urine dipstick is positive for blood, though no RBCs are seen on microscopy. MRI imaging shows edema and inflammation of the anterior compartment of the thighs, with patent blood vessels and no evidence of nerve damage (see image 1).