Introduction: Acute compartment syndrome is most commonly seen in the lower limb. Only four cases have been reported in the paraspinal muscles. The common features of this condition have not been described.

Methods: Following the successful surgical treatment of a case of bilateral paraspinal muscle compartment syndrome, a thorough search was made of all similar cases in Medline, and by hand-searching of references lists.

Results: Only four other cases of non-traumatic paraspinal compartment syndrome were identified in the literature. Closer analysis revealed many features in common with our case. The condition tends to occur in skiers in their 20s with a previous history of exercise-induced back pain. Patients present with paraspinal muscle spasm and loss of sensation of the loin, after a few days of heavy exertion. There is abdominal tenderness and bowel sounds are reduced. Consistent findings on blood chemistry are marked elevation of creatinine kinase, myoglobin and LDH. There is an associated myoglobinuria. MRI is helpful in identifying extent of muscle involvement and guiding surgical intervention. The most useful investigation is the direct measurement of compartment pressures. Treatment can be operative or non-operative, although surgery is associated with more rapid recovery and elimination of pain.

Discussion and Conclusion: The common features of acute paraspinal compartment syndrome of non-traumatic origin have not previously been recognised. We have helped define the characteristics of this condition to aid earlier recognition and treatment.