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Review
. 2013 Sep 2:14:259.
doi: 10.1186/1471-2474-14-259.

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

Georg Mattiassich  1 , Lorenz Larcher, Markus Leitinger, Eugen Trinka, Gottfried Wechselberger, Heinrich Schubert
Affiliations
Review

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

Georg Mattiassich et al. BMC Musculoskelet Disord. .

Abstract

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.

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Figures

Figure 1
Figure 1
Magnetic resonance imaging (T1-weighted with gadolinium) showing edema and high signal intensity (arrows) in the region of the left multifidus and longissimus muscles.
Figure 2
Figure 2
Ischemic non-contractile muscle (arrow).
Figure 3
Figure 3
Creatine phosphokinase (CPK) over time.
Figure 4
Figure 4
Necrosis of the multifidus muscle with increased interstitial edema (hematoxylin and eosin staining, original magnification × 100).
Figure 5
Figure 5
Magnetic resonance imaging (T1-weighted with gadolinium) showing cystic changes (arrow) in the multifidus muscle at 4 weeks after the operation.
See this image and copyright information in PMC

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