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Lift the quilt in case of atrial fibrillation and disc prolapse

Authors Bastovansky, Ziegler, Stöllberger, Finsterer J

Received 23 February 2012

Accepted for publication 9 March 2012

Published 22 June 2012 Volume 2012:8 Pages 389—392

DOI https://doi.org/10.2147/VHRM.S31156

Review by Single-blind

Peer reviewer comments 2

Adam Bastovansky,1 Kathrin Ziegler,2 Claudia Stöllberger,2 Josef Finsterer3

1Department of Radiology, 2Medical Department, Krankenanstalt Rudolfstiftung, Vienna, Austria; 3Danube University Krems, Krems, Austria

Background: Peripheral embolism to the lower extremities may mimic disc prolapse with severe consequences.
Case report:  A 71-year-old male with a history of chronic alcoholism developed low back pain radiating to both lower extremities in a nonradicular distribution and bilateral dysesthesias of the distal lower legs after lifting a heavy weight. Given that magnetic resonance imaging (MRI) of the lumbar spine showed disc herniation in L3/4 and L4/5, he was scheduled for laminectomy but was unable to undergo surgery due to thrombocytopenia. After transfer to another hospital, persistence of symptoms and signs, absent pulses on the distal lower legs, and rhabdomyolysis with temporary renal insufficiency, peripheral embolism with compartment syndrome was suspected. Magnetic resonance angiography revealed occlusion of the right superficial femoral artery and long high-grade stenosis of the left superficial and profound femoral arteries and distal arteries. He successfully underwent embolectomy and fasciotomy.
Conclusions: If lumbar pain is not radicular, peripheral pulses are minimally palpable, and distal limbs are cold and show livid decolorization, peripheral embolism is much more likely than disc herniation, particularly if the patient's history is positive for atrial fibrillation. MRI of the lumbar spine must be interpreted in conjunction with clinical presentation.

Keywords: embolism, compartment syndrome, neurosurgery, embolectomy, fasciotomy, rhabdomyolysis

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