1618. Lumbar Paraspinal Compartment Syndrome

Authors: Brian Patrick Curry, MD; Nicholas Szuflita, MD; Michael Dirks, MD; George Rymarczuk, MD (Bethesda, MD)

Introduction: Paraspinal compartment syndrome is a rare entity, with fewer than 25 cases reported in the literature. Methods: Here we report a case of a young male active-duty soldier with a history of sickle cell trait who developed paraspinal compartment syndrome after participating in a physical fitness test. Results: A 27-year-old young man developed gradual-onset severe axial low back pain several hours after vigorous physical activity. Physical examination was notable only for exquisite tenderness over the lower lumbar paraspinal musculature. Laboratory investigation revealed profound transaminitis and acute renal failure, as well as dramatic elevations in serum creatinine kinase and myoglobin. Contrast-enhanced MRI of the lumbar spine demonstrated multiple abnormalities in the lumbar paraspinal musculature, including diffuse abnormal T2 signal, suggestive of muscular edema; scattered regions of T1 abnormality, suggestive of intramuscular hemorrhage; and abnormal regions of heterogenous contrast uptake, indicating muscular necrosis. He was treated with analgesic medications and intravenous hydration, and experienced improvement in his pain and metabolic derangements over the ensuing days, thus avoiding fasciotomy. Conclusion: Lumbar paraspinal compartment syndrome is a rare diagnosis, but should be considered in the differential diagnosis for patients with exquisite axial back pain after vigorous activity. Laboratory investigation is consistent with rhabdomyolysis. Magnetic resonance imaging is to confirm the diagnosis and exclude alternate etiologies. Fasciotomy may be necessary for cases refractory to medical management.