Anatomic features of the lumbar paraspinal compartment:
(1) The space consists of the erector spinae muscles surrounded by the middle and posterior lamellae of the lumbodorsal fascia.
(2) The caudal boundary is the sacrum and iliac crests.
(3) The posterior boundary is the lumbosacral fascia.
(4) The anterior boundary is the thoracolumbar fascia, iliolumbar ligaments, transverse processes, vertebral laminae, intertransverse muscles, and intertransverse ligaments.
(5) The lateral boundary is the fusion of the anterior and posterior portions of the thoracolumbar fascia.
(6) The medial boundary is the spinous processes, interspinous ligaments, and the attachments of the thoracolumbar fasciae.
Blood supply: 4 pairs of dorsal branches from the segmental lumbar arteries
Precipitating factors:
(1) trauma
(2) strenuous exercise
(3) surgery on the abdominal aorta
(4) severe atherosclerosis or atheroemboli from the abdominal aorta
Clinical findings:
(1) low back pain of sudden onset
(2) tenderness, swelling and rigidity of the paravertebral muscles
(3) limited spine movement
(4) evidence of rhabdomyolysis with elevated serum CK and LDH and myoglobinuria
(5) muscle swelling on imaging studies (Technetium 99 bone scan may be helpful)
(6) increased compartment pressures (if pressures measured)
Management:
(1) Usually conservative measures are tried with treatment of the rhabdomyolysis to prevent acute renal failure, analgesics and bed rest.
(2) Fasciotomy and muscle debridement may be performed in severe cases, but this may increase the risk of infection other complications.
