[A CASE OF LEFT SPINAL ERECTOR SPINAE COMPARTMENT SYNDROME AFTER RETROPERITONEOSCOPIC RIGHT NEPHRECTOMY FOR WHICH DECOMPRESSIVE FASCIOTOMY WAS EFFECTIVE].

Abstract

The patient was a male in his 60s who underwent a retroperitoneoscopic right nephrectomy for a diagnosis of right renal cell carcinoma (cT3aN0M0). During surgery, the patient was positioned in the left lateral recumbent, jackknife position. A blood test of the day after surgery showed an abnormally high CK level of 23,038 U/L. However, because his only symptom was mild pain in the left lower back, the patient was placed under follow-up observation. Two days postoperatively, the patient had worsening left lumbago, swelling, stiffness, and paresthesias in the left lumbar region. A simple CT scan showed internal hypo-absorption and increased volume of the left erector spinae muscle. With a diagnosis of left erector spinae compartment syndrome, the patient underwent an emergency decompressive fasciotomy by an orthopedic surgeon. The patient's postoperative course was uneventful with no sequelae, and he was discharged on postoperative day 22.In this case, the increased pressure on the lumbar region due to the cushion inserted into the lumbar flexion to reinforce the jackknife position was thought to have contributed significantly to the development of erector spinae compartment syndrome.Although erector spinae compartment syndrome is very rare after lateral recumbency surgery, taking thorough precautions is necessary, including the decompression of as much pressure as possible in the preoperative position and appropriate intraoperative blood pressure control, and to deal with it promptly, including fasciotomy in case of postoperative low back pain that coincides with the surface of the operating table.