Paravertebral compartment syndrome after training causing severe back pain in an amateur rugby player: report of a rare case and review of the literature

BMC Musculoskeletal Disorders

Heinrich Schubert²  Gottfried Wechselberger²  Eugen Trinka¹  Markus Leitinger¹  Lorenz Larcher²  Georg Mattiassich³ 

[1] Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University and Salzburger Landeskliniken, Salzburg, Austria;Department of Plastic and Reconstructive Surgery, St. John of God Hospital, Teaching Hospital of the Paracelsus Medical University Salzburg, Linz, Austria;Trauma Center Unfallkrankenhaus Linz, Teaching Hospital of the Paracelsus Medical University Salzburg, Linz, Austria

关键词: Lumbago;    Lumbar spine;    Fasciotomy;    Back pain;    Paravertebral compartment syndrome;   

Others  :  1129776
DOI  :  10.1186/1471-2474-14-259

 received in 2013-03-22, accepted in 2013-08-30,  发布年份 2013

【 摘 要 】

Background

Acute compartment syndrome (CS) of the paravertebral muscles without external trauma is rarely reported in literature. Not all of clinical symptoms for CS are applicable to the paravertebral region.

Case presentation

A 30-year-old amateur rugby player was suffering from increasing back pain following exertional training specially targeting back muscles. He presented with hardly treatable pain of the lumbar spine, dysaesthesia of the left paravertebral lumbar region as well as elevated muscle enzymes. Magnetic resonance imaging (MRI) showed an edema of the paravertebral muscles. Compartment pressure measurement revealed increased values of 47 mmHg on the left side. Seventy-two hours after onset of back pain a fasciotomy of the superficial thoracolumbar fascia was performed. Immediately postoperatively the clinical condition improved and enzyme levels significantly decreased. The patient started with light training exercises 3 weeks after the operation.

Conclusions

We present a rare case of an exercise-induced compartment syndrome of the paravertebral muscles and set it in the context of existing literature comparing various treatment options and outcomes. Where there is evidence of paravertebral compartment syndrome we recommend immediate fasciotomy to prevent rhabdomyolysis and further consequential diseases.

【 授权许可】

   
2013 Mattiassich et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Echtermeyer V: [Compartment syndrome]. Unfallchirurg 1997, 100(12):923.
• [2]Chopra R, Hayton M, Dunbar PJ: Exercise induced chronic compartment syndrome of the first dorsal interosseous compartment of the hand: a case report. Hand (N Y) 2009, 4(4):415-417.
• [3]Zandi H, Bell S: Results of compartment decompression in chronic forearm compartment syndrome: six case presentations. Br J Sports Med 2005, 39(9):e35.
• [4]Cetinus E, Uzel M, Bilgic E, Karaoguz A, Herdem M: Exercise induced compartment syndrome in a professional footballer. Br J Sports Med 2004, 38(2):227-229.
• [5]King TW, Lerman OZ, Carter JJ, Warren SM: Exertional compartment syndrome of the thigh: a rare diagnosis and literature review. J Emerg Med 2010, 39(2):e93-99.
• [6]Carr D, Gilbertson L, Frymoyer J, Krag M, Pope M: Lumbar paraspinal compartment syndrome. A case report with physiologic and anatomic studies. Spine (Phila Pa 1976) 1985, 10(9):816-820.
• [7]Peck D, Nicholls PJ, Beard C, Allen JR: Are there compartment syndromes in some patients with idiopathic back pain? Spine (Phila Pa 1976) 1986, 11(5):468-475.
• [8]Nathan ST, Roberts CS, Deliberato D: Lumbar paraspinal compartment syndrome. Int Orthop 2012, 36(6):1221-1227.
• [9]Wiltse LL, Bateman JG, Hutchinson RH, Nelson WE: The paraspinal sacrospinalis-splitting approach to the lumbar spine. J Bone Joint Surg Am 1968, 50(5):919-926.
• [10]Whitesides TE, Heckman MM: Acute Compartment Syndrome: Update on Diagnosis and Treatment. J Am Acad Orthop Surg 1996, 4(4):209-218.
• [11]Mubarak SJ, Owen CA, Hargens AR, Garetto LP, Akeson WH: Acute compartment syndromes: diagnosis and treatment with the aid of the wick catheter. J Bone Joint Surg Am 1978, 60(8):1091-1095.
• [12]Mubarak SJ, Pedowitz RA, Hargens AR: Compartment syndromes. Curr Orthop 1989, 3:36-40.
• [13]Matsen FA 3rd, Rorabeck CH: Compartment syndromes. Instr Course Lect 1989, 38:463-472.
• [14]Songcharoen P, Chotigavanich C, Thanapipatsiri S: Lumbar paraspinal compartment pressure in back muscle exercise. J Spinal Disord 1994, 7(1):49-53.
• [15]Konno S, Kikuchi S, Nagaosa Y: The relationship between intramuscular pressure of the paraspinal muscles and low back pain. Spine (Phila Pa 1976) 1994, 19(19):2186-2189.
• [16]Styf J, Lysell E: Chronic compartment syndrome in the erector spinae muscle. Spine (Phila Pa 1976) 1987, 12(7):680-682.
• [17]Khan RJ, Fick DP, Guier CA, Menolascino MJ, Neal MC: Acute paraspinal compartment syndrome. A case report. J Bone Joint Surg Am 2005, 87(5):1126-1128.
• [18]DiFazio FA, Barth RA, Frymoyer JW: Acute lumbar paraspinal compartment syndrome. A case report. J Bone Joint Surg Am 1991, 73(7):1101-1103.
• [19]Kitajima I, Tachibana S, Hirota Y, Nakamichi K: Acute paraspinal muscle compartment syndrome treated with surgical decompression: a case report. Am J Sports Med 2002, 30(2):283-285.
• [20]Paryavi E, Jobin CM, Ludwig SC, Zahiri H, Cushman J: Acute exertional lumbar paraspinal compartment syndrome. Spine (Phila Pa 1976) 2010, 35(25):E1529-1533.
• [21]Xu YM, Bai YH, Li QT, Yu H, Cao ML: Chronic lumbar paraspinal compartment syndrome: a case report and review of the literature. J Bone Joint Surg Br 2009, 91(12):1628-1630.
• [22]Bogduk N: A reappraisal of the anatomy of the human lumbar erector spinae. J Anat 1980, 131(Pt 3):525-540.