Pneumocephalus and Pneumorrhachis after Spinal Surgery: Case Report and Review of the Literature

Abstract

Trauma is a common cause of pneumocephalus, or air in the cranial cavity, and of pneumorrhachis, or the presence of intraspinal air. After spinal surgery, occurrence of pneumocephalus, especially with pneumorrhachis, is extremely rare. We report the case of a patient who developed pneumocephalus and pneumorrhachis after lumbar disc surgery and pedicle screw fixation. There was no cerebrospinal fluid leakage during surgery. On postoperative day 1, the patient complained of headache, nausea, and dizziness. Brain and lumbar computed tomography scans revealed pneumocephalus and pneumorrhachis. With conservative treatment, the patient's complaints resolved within 10 days.

Postoperative symptomatic haematoma and pneumorrhachis in a dog with a thoracolumbar intervertebral disc extrusion

“…This case report describes the occurrence and successful management of PR after spinal surgery as the cause of early postoperative neurological deterioration. Although postoperative or iatrogenic PR has been reported in human medicine, it is considered very rare …”

“…Second, spontaneous and postoperative PR can be associated with the ‘vacuum phenomenon’, which is produced by the liberation of gas from the extracellular fluid that accumulates within the cracks, clefts or crevices that form in degenerated intervertebral discs . Third, the ‘inverted bottle’ mechanism, whereby an arachnoid tear created by the primary aetiology (intervertebral disc extrusion) causes cerebrospinal fluid leakage, resulting in a negative pressure gradient and allowing gas to flow into the subarachnoid space …”

“…Conservative management consisting of bed rest, hyperhydration and inhalation of 100% oxygen are adequate for the majority of human patients with postoperative PR . In human medicine, conservative management is usually attempted first and surgical treatment is generally reserved for patients not responding adequately to medical management . Surgical intervention typically consists of needle aspiration or open surgical removal of the intraspinal air .…”

“…Although postoperative or iatrogenic PR has been reported in human medicine, it is considered very rare. [7][8][9] Although the exact pathophysiology of postoperative PR is still unknown, three different hypotheses have been suggested. First, air that enters the surgical site during surgery can get trapped when blood binds the soft tissue margins of the wound, forming a membrane that encases the gas collection.…”

A Case of Cerebrospinal fluid leakage and Pneumocephalus Secondary to Thoracic spine Knife Injury

“…Pnömosefali genellikle herhangi bir klinik belirti vermeksizin absorbe olur. Tedavi 30 derece Fowler pozisyonu verme, valsalva manevrasından sakınma, analjezik, antipiretik ve ozmotik diürezdir (1,13) . Hastanın hayatını tehdit eden intrakraniyal basınç artışı ya da bilinç bozukluğu gelişirse acil dekompresyon yapılmalıdır (1) .…”