Conservative Management of a Rare Clinical Phenomenon: Paraspinal Compartment Syndrome – A Review of Existing Literature
Authors:   Department of Orthopedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, United States of America,, LaGreca Mark , Badragheh Arash ,   Department of Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, United States of America., Jones Nathan ,   Department of Orthopedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, United States of America,, Falconiero Thomas ,   Department of Orthopedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, United States of America,, Danshaw Brian ,   Department of Orthopedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, United States of America,
Published: December 2024

Introduction: This review of case series and case reports explores conservative management strategies for paraspinal compartment syndrome (PCS), a rare clinical condition. Extremity compartment syndrome has been shown to be managed most effectively with emergent surgical release of the fascial compartment. Given the rarity of PCS and the paucity of research in the literature, some authors have suggested the possibility of conservative treatment. There has been no study to date that has specifically investigated the cases of non-operative management of PCS.

Materials and Methods: There are 16 case reports in the literature with 22 cases of PCS treated conservatively. The authors reviewed these cases, specifically viewing the clinical courses, why the decision was made to manage conservatively, and the reported outcomes.

Results: The etiology of PCS varied, with weightlifting being the primary cause in 11 out of 22 cases, followed by strenuous sporting events and postsurgical complications. All patients in this review were male, aged between 18 and 61 years old. Acute presentations exhibited severe back pain, rigid paraspinal musculature, and subjective paraspinal paresthesias. Magnetic Resonance Imaging findings of the spine revealed profound bilateral symmetric intramuscular edema. Among the cases, 8 explicitly reported a return to normal function, while 8 continued to experience symptoms related to the initial injury. Nine cases chose conservative measures primarily because of delayed presentation, seven instances reported successful outcomes with conservative measures; one case cited concerns about infection risk.

Discussion: The probability of underreporting related to PCS may result in a substantial number of cases being omitted from medical literature. Pathologically, PCS is characterized by increased intra-compartmental pressure, triggering rhabdomyolysis due to significant soft tissue damage. Emergent surgical intervention is the treatment of choice for any compartment syndrome; however, conservative management of these cases has shown satisfactory clinical outcomes. Hyperbaric oxygen therapy emerges as a potential adjunctive treatment to enhance tissue viability, though its efficacy and accessibility warrant further investigation in the context of PCS management.

Conclusion: Early recognition and treatment of PCS are critical in preventing chronic pain and permanent complications. Given the limitations identified in non-operative management, further research is imperative to optimize treatment strategies.

Keywords: Paraspinal compartment syndrome, conservative management, back pain.