Acute Paravertebral Compartment Syndrome: Follow-up and Literature Review

Abstract

Objective: To report on a patient with acute paravertebral and posterior thigh compartment syndrome after vigorous exercise.

Background: Paravertebral compartment syndrome (PCS) is a rare clinical entity, typically occurring in male athletes after heavy exertion and weightlifting.

Case: A 25-year-old man presented with back pain and hematuria hours after back-specific weightlifting. Clinical examination, laboratory markers, MRI, and elevated intracompartmental pressure measurements supported the diagnosis of bilateral paravertebral and posterior thigh compartment syndrome. The patient underwent paravertebral decompression via the Wiltse approach with immediate postoperative relief. He is doing well at 1 year, with recovery of lumbar extension strength, although MRI demonstrates moderate fatty replacement of paravertebral musculature.

Conclusions: Although rare, early recognition of PCS and timely decompression can limit myonecrosis. Paravertebral compartment syndrome should be considered in the differential for athletic individuals with acute onset back pain.

Study design: A case report and review of literature.

Figure 1

Magnetic resonance images taken at L4 as (A) T1, (B) T1-fat suppressed, with contrast, and (C) T2-weighted. Note the posterior paravertebral musculature enlargement and heterogeneous signal abnormality.

Figure 2

Intraoperative photographs of the Wiltse approach demonstrating myonecrosis (A) and low-power ×40 (B) and high-power ×200 (C) slides of hemotoxylin-and-eosin–stained tissue from the lumbar spinal musculature in the permanent section, with areas of extensively necrotic skeletal muscle with acute inflammatory infiltrate and abundant necrotic debris.

Figure 3

Magnetic resonance images taken at L4 at 1-year follow-up as (A) T1- and (B) T2-weighted, demonstrating fatty change of paravertebral musculature.