Clinical study of the chronic lumbar pain induced by chronic compartment syndrome

doi:10.3321/j.issn:1673-8225.2004.05.009

Abstract：BACKGROUND: So far, information about the clinical diagnosis and treatment of lumbar pain induced by chronic compartment syndrome(CCS), and pathophysiological changes of skeleton muscles then remains insufficient.OBJECTIVE: To explore the clinical diagnosis and management of lumbar pain induced by chronic lumbosacral compartment syndrome and relevant pathophysiologic changes of skeleton muscles (SM). DESIGN: None-randomized self-control, retrospective trial.SETTING AND PARTICIPANTS: Thirty-three patients diagnosed as with CCS suffering from lumbar pain for 2 to 42 years with a mean course of 27 years, who received treatment in the General Hospital of Beijing Command, 15 males and 18 females, aged 18 - 66 with a mean age of 42.3.METHODS: Microsurgical depression of fasciotomy(DOF) in lumbosarcal erect spinal muscle(ESM) was applied followed by waist and abdominal muscles functional exercise. A self-designed pressure-measuring needle with a lateral aperture and a micro-pressoreceptive apparatus was penetrated into the ESM at the level of L3 spinal prominence to test the ICP at rest, during exercise and 6 main after exercise. MAIN OUTCOME MEASURE: Low-back pain, walking ability, anteflexion and backward extension activity, as well as lumbosacral blood flow (LBF) measured by ultrasonic Doppler technique and intracompartment pressure (ICP) at rest, during exercise, and after exercise were observed.RESULTS: Obviously alleviated low-back pain and increased walking ability were observed after operation, lumbar anteflexion and backward extension activity increased by (15 ±0.5)° and (7±0.7)° respectively. The values of lumbosacral ICP after operation were(0.9±0.1), (21.6±1.6), and (0.9±0.1) lkPa, at rest, during exercise, and 6 minute after exercise respectively, all significantly lower than those before operation, (1.4±0.1), (24.9±1.5), and(1.8±0.2)kPa (t=2.04,2.32,3.21, P ＜0.05 or 0.01) . Optical microscopy showed degeneration, punctate atrophy and necrosis of ESM. Electron microscopy showed scattered disorderly arrangement of SM fibers with multiple fibrosis. Ultrasonic Doppler technique showed obviously increased LBF in SM in comparison with that before-operation. CONCLUSION: Clinical examination combined with ICP measurement is reliable for diagnosing chronic lumbar pain related to lumbosacral compartment syndrome, and DOF can be used in treatment.