Compartment syndrome of lumbar paraspinal musculature after percutaneous pedicle screw fixation

Compartment syndromes have been reported in nearly every anatomical area of the extremities. Similarly, in the lumbar spine, there is a risk of a compartment syndrome following either direct or indirect injury to the paraspinal muscles. In this study, we present a case of lumbar paraspinal compartment syndrome after percutaneous pedicle screw fixation for a spine fracture.

A 27-year-old obese female sustained a fall and an L1 fracture. Her neurological examination was normal. She underwent a minimally invasive percutaneous posterior pedicle screw fixation from T12 to L2 to stabilize the L1 fracture. Postoperatively, the patient developed hypoesthesia in the back, and sterile serous wound discharge. Because of the persistent discharge, an open debridement was performed that revealed multiple cavities within the necrotic avascular paraspinal musculature. Once these were completely excised, the wounds healed uneventfully.

Patients undergoing minimally invasive posterior thoracolumbar (TL) pedicle screw fixation can develop a compartment syndrome involving the TL paraspinal musculature. This case highlights the need for early consideration of a compartment syndrome when patients develop persistent sterile discharge after spine surgery. In this case, urgent decompression prevented any long-term sequelae.