Page 75 - JSOM Summer 2024

Lumbar Paraspinal Compartment Syndrome

in an Active-Duty Army Special Operations Aviation Soldier

Christopher Wagner, MD, MC *; Gerrit W. Davis, MD, MC ;
2
1
Matthew Donato, 18D, SOCM-ATP ; Patrick Bedard, MD, MC ;
3
4
Rachel E. Bridwell, MD, MC, FS 5

ABSTRACT
Lumbar paraspinal muscle compartment syndrome is an un- limited data exist on the incidence of LPMCS. This disease pro-
common, rapidly progressive, and potentially devastating cess presents most commonly in young adult males engaging in
injury with fewer than 40 cases reported in the literature. It high-intensity physical activity such as weightlifting or extreme
initially mimics nonemergent causes of low back pain, dispro- sports, though it can occur as a result of direct trauma or as a
portionately affects young men, and is most often secondary to result of non-spinal surgery. 4,5
acute physical exertion. The disease process is commonly asso-
ciated with rhabdomyolysis. Diagnostic tools include physical ACS is defined as compartment pressure 30mmHg above the
examination, measurement of lactate and creatine kinase levels, patient’s diastolic blood pressure or an absolute intracompart-
MRI, and direct compartment pressure measurement. While mental pressure greater than 30mmHg, most often second-
medical and nonoperative management strategies have been ary to edema in the setting of muscular tissue damage from
explored, the gold standard for treatment is emergent lumbar exertion or direct trauma. As a consequence, circulation is
5
fasciotomy. Opioid and non- steroidal pain management, as critically impaired to local tissue and all structures distal to
well as physical therapy, are the mainstays of post-treatment the occluded vasculature. True incidence of ACS is unknown,
5
recovery, with many surgical patients reporting complete symp- as fasciotomy is the surrogate for determining the diagnosis.
tom resolution at long-term follow-up. This article discusses More particularly, only 37 cases of LPMCS have been reported
the case of a 27-year-old, male, active-duty, Special Operations in the literature to date. By comparison, chronic exertional
5,6
Aviation Soldier who presented to the emergency department compartment syndrome is estimated at an incidence of 0.49
and was found to have lumbar paraspinal muscle compartment cases per 1,000 person years in the military population, dis-
syndrome. proportionately affecting junior enlisted Servicemembers. 7
Keywords: lumbar; paraspinal; compartment syndrome; back Although reversible with early intervention, LMPCS often re-
pain; rhabdomyolysis; fasciotomy sults in long-term sequelae, including contractures, local tissue
loss, neuropathy, and chronic kidney disease. Additionally,
8
compartment syndrome is a rare but serious complication of ex-
ertional rhabdomyolysis. Exertional rhabdomyolysis incidence
9
Introduction
has been reported at 29.9 per 100,000 person years among the
Low back pain is the most common sequela of musculoskeletal general population, whereas incidence among the military pop-
injury in the United States Army, with an overall incidence as ulation was 30% higher at 38.9 per 100,000 person years. 9,10
high as 40.5 per 1,000 person years, more commonly affect-
ing junior enlisted Soldiers and those involved in physically de- The authors present a case of paraspinal compartment syn-
manding occupations. Among Special Operations Soldiers with drome in a 27-year-old male Special Operations aviation
1
no history of back pain, as many as 64% will report moderate aircraft maintainer with multiple visits to the emergency de-
back pain within 18 months of duty. Nontraumatic musculo- partment (ED) with back pain following exercise and strenu-
2
skeletal strain is the most frequent cause, though more serious ous aircraft maintenance.
etiologies include cauda equina syndrome, osteomyelitis, ab-
dominal aortic aneurysm, aortic dissection, metastatic disease, Case Presentation
rhabdomyolysis, pyomyositis, Guillain-Barré syndrome, and
myonecrosis. A rare etiology of back pain with potentially A 27-year-old male Special Operations Aviation Soldier pre-
devastating outcomes is acute lumbar paraspinal muscle com- sented to the ED with acute onset left-sided low back pain
partment syndrome (LPMCS). LPMCS represents a specific after folding helicopter rotor blades during scheduled air-
3
manifestation of acute compartment syndrome (ACS), and craft maintenance. He also reported routine caffeine use not
*Correspondence to chris.wagner89@gmail.com
1 CPT Christopher Wagner, CPT Gerrit W. Davis, CPT Patrick Bedard, and CPT Rachel E. Bridwell are affiliated with the Department of
2
4
5
3
Emergency Medicine, Madigan Army Medical Center, WA. SSG Matthew Donato, is affiliated with the 25th Special Forces Group, Fort Camp-
bell, TN.
73