Page 78 - JSOM Summer 2024

FIGURE 4 Lumbar paraspinal compartment syndrome evaluation and management flowchart.

CK = creatine kinase; AST = aspartate transferase; ALT = alanine transferase; Cr = serum creatinine.

prophylactic fasciotomy as definitive treatment to prevent Army Special Operations Command, the U.S. Army Office of
LPMCS complications. The mainstays of treatment for both the Surgeon General, the Department of the Army, Depart-
LPMCS and rhabdomyolysis are multimodal pain control ment of Defense or the U.S. Government.
and fluid resuscitation. More research is required to recom-
mend hyperbaric oxygen therapy and urine alkalinization in References
advance of definitive treatment with fasciotomy. Following 1. Knox J, Orchowski J, Scher DL, Owens BD, Burks R, Belmont PJ.
compartment release with fasciotomy, supportive care and The incidence of low back pain in active duty United States mil-
physical therapy are crucial to mitigate long-term sequelae. itary service members. Spine (Phila Pa 1976). 2011;36(18):1492–
1500. doi:10.1097/BRS.0b013e3181f40ddd
Though rare, LPMCS presents an unusual but mission- and 2. Cohen SP, Gallagher RM, Davis SA, Griffith SR, Carragee EJ.
life- threatening cause of low back pain. Special Operations Spine-area pain in military personnel: a review of epidemiology,
providers should maintain an increased index of suspicion etiology, diagnosis, and treatment. Spine J. 2012;12(9):833–842.
with back pain refractory and progressive despite multiple doi:10.1016/j.spinee.2011.10.010
treatments and should prompt consideration for rapid evacu- 3. Edwards J, Hayden J, Asbridge M, Magee K. The prevalence of low
ation to a surgical asset. back pain in the emergency department: a descriptive study set in
the Charles V. Keating Emergency and Trauma Centre, Halifax,
Nova Scotia, Canada. BMC Musculoskeletal Disord. 2018;19(1):
Author Contributions 306. doi:10.1186/s12891-018-2237-x.
CW, GD, and PB provided care for this patient in the ED. RB 4. Ahmed T, Safdar A, Ahmed T, Ahmad T, Losonczy L. Acute
and MD provided follow-up care post discharge. CW, GD, and paraspinal compartment syndrome in an unconscious patient. Cu-
MD wrote the case report. PB and RB reviewed and edited the reus. 2020;12(3):e7216. doi:10.7759/cureus.7216
report, as well as provided additional research. 5. Ilyas H, Fagan C, Roser F, Hebela NM. Lumbar paraspinal com-
partment syndrome: Case Report and Critical Evaluation of the Lit-
erature. Clin Spine Surg. 2022;35(7):301–309. doi: 10.1097/BSD.
Disclosures 0000000000001254.
The authors have nothing to disclose. 6. Osborn CPM, Schmidt AH. Management of acute compartment
syndrome. J Am Acad Orthop Surg. 2020;28(3):e108-e114. doi:
Funding 10.5435/JAAOS-D-19-00270
No funding was received for this work. 7. Waterman BR, Liu J, Newcomb R, Schoenfeld AJ, Orr JD, Bel-
mont PJ. Risk factors for chronic exertional compartment syn-
drome in a physically active military population. Am J Sports Med.
Disclaimer 2013;41(11):2545–2549. doi:10.1177/0363546513497922
The views expressed herein are those of the authors and do not 8. Alexander W, Low N, Pratt G. Acute lumbar paraspinal compart-
reflect the official policy or position of Madigan Army Medi- ment syndrome: a systematic review. ANZ J Surg. 2018;88(9):
cal Center, the U.S. Army Medical Department, United States 854–859. doi:10.1111/ans.14342

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