Paraspinal compartment syndrome after minimally invasive thoracolumbar fixation: a case report

Minimally invasive spinal surgery has revolutionized the treatment of traumatic thoracolumbar compression fractures. However, rare and potentially serious complications, such as paraspinal compartment syndrome, may still occur.

A 20-year-old Chinese male soldier sustained a T12 compression fracture and underwent successful minimally invasive percutaneous pedicle screw fixation from T11 to L1. The initial postoperative course was uneventful. On postoperative day 16, he developed severe back pain, serous fluid discharge, and localized paraspinal swelling. This prompted readmission and emergency surgical debridement. Intraoperative findings revealed pale, avascular, and noncontractile paravertebral muscles bilaterally. Pathological examination confirmed skeletal muscle necrosis, establishing the diagnosis of thoracolumbar paravertebral myofascial compartment syndrome. Aggressive management with serial debridements, negative-pressure wound therapy, and appropriate antibiotic therapy led to complete wound healing and full recovery, allowing him to resume military training.

This case underscores the critical importance of early recognition and prompt surgical intervention in managing paraspinal compartment syndrome. Even in minimally invasive spinal surgery, enhanced intraoperative measures and vigilant postoperative monitoring are necessary to prevent such rare but potentially devastating complications.