Lumbar paraspinal compartment syndrome with concomitant rhabdomyolysis and multifidus necrosis

Acute lumbar paraspinal compartment syndrome is a rare, function-threatening emergency often misidentified as benign musculoskeletal strain. We describe a 29-year-old male who presented to the emergency department (ED) with acute low back pain following a touch football game. Despite an initial discharge for muscle spasm, he returned 24 h later with refractory pain and laboratory evidence of rhabdomyolysis (creatine kinase 14,399 U/L). Magnetic resonance imaging revealed edema of the left paraspinal musculature. Due to persistent pain and progressive laboratory abnormalities, emergent surgical decompression was performed, confirming multifidus necrosis. This case highlights the bounce-back presentation as a critical red flag. Prompt recognition of disproportionate pain and unexplained rhabdomyolysis in the ED is essential to facilitate emergent fasciotomy and prevent irreversible myonecrosis and acute kidney injury.