Epidurale Luft im Spinalkanal bei Pneumomediastinum

Pathogenesis, diagnosis and management of pneumorrhachis

“…Free air surrounding the dura mater spinalis is an uncommon phenomenon that was primarily reported by Gordon et al [ 30 ] in 1977 and described under various terms such as intraspinal pneumocele [ 28 , 38 , 50 ] or pneumocoele [ 78 ], spinal epidural and subarachnoid pneumatosis [ 4 – 6 , 9 , 18 , 19 , 32 – 34 , 41 , 47 , 61 , 74 ], spinal and epidural emphysema [ 4 , 11 , 23 , 27 , 28 , 33 , 59 , 65 , 69 , 70 , 72 , 77 ], aerorachia [ 18 , 22 , 28 , 34 ], pneumosaccus [ 9 , 28 , 62 ], air myelogram [ 2 , 30 , 76 ], pneumomyelogram [ 2 , 3 , 12 , 17 , 20 , 28 , 30 , 76 ] or pneumomyelography [ 26 ]. The term PR itself was first coined 10 years later by Newbold and co-workers [ 54 ].…”

“…Various conditions may directly or indirectly produce PR including trauma [ 1 – 3 , 9 , 10 , 12 , 13 , 17 , 20 – 22 , 26 – 28 , 30 , 32 , 37 – 42 , 45 , 50 , 51 , 54 , 60 , 62 , 64 , 66 – 68 , 73 , 74 , 76 , 78 ], respiratory complications and conditions that produce high intrathoracic pressure and barotraumas [ 5 , 6 , 11 , 14 , 19 , 22 – 24 , 33 , 40 , 47 , 55 , 56 , 58 , 59 , 61 , 69 , 70 , 72 , 77 ], recent iatrogenic manipulations during surgical, anaesthesiological and diagnostic interventions [ 7 , 9 , 15 , 18 , 31 , 33 , 35 , 36 , 44 , 48 , 52 , 53 , 57 , 65 , 71 ], malignancy and its associated therapy [ 29 , 49 , 63 ,…”

“…Invasive tumour progression and postradiation changes [ 29 , 49 , 63 , 75 ], surgical interventions [ 33 , 36 , 65 , 71 ], nasotracheal intubation [ 18 ] and peri- or epidural anaesthesia involving a lumbar puncture [ 7 , 9 , 15 , 31 , 35 , 44 , 48 , 52 , 53 , 57 ] have also been reported as a cause of PR. Introduction of air as a negative contrast medium into the lumbar subarachnoid space for diagnostic pneumoencephalography or pneumomyelogram, first performed and described by Dandy in 1919, is now only of historical interest [ 16 ].…”

“…Two documented cases with air in the entire spinal canal [ 12 , 55 , 56 ], single cases of air bubbles distributed in the cervical, thoracic and lumbar region [ 35 ], and in the cervical and lumbar spine [ 10 ], six cases of air in the thoracic and lumbar region [ 7 , 9 , 15 , 26 , 57 ] and eight cases with both cervical and thoracic PR were previously described [ 1 , 11 , 26 , 32 , 47 , 52 , 63 , 77 ]. Most cases demonstrate isolated PR of the cervical [ 2 , 3 , 5 , 10 , 17 , 20 , 30 , 38 , 39 , 45 , 50 , 51 , 54 , 60 , 66 , 68 , 69 , 74 , 76 , 78 ], thoracic [ 4 , 6 , 14 , 18 , 19 , 21 – 24 , 27 , 29 , 33 , 34 , 37 , 40 – 42 , 49 , 58 , 59 , 61 , 64 , 65 , 67 , 70 – 75 ] or lumbosacral region [ 9 , 10 , 13 ...…”