Pneumorrhachis following cervical spine surgery

Bautista, Manuel; Wright, Jeff; Pippalapalli, J.; Schramm, Moritz; Pandit, Mayukh

doi:10.1002/anr3.12137

Cited by 3 publications

(4 citation statements)

References 10 publications

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“…Another crucial factor to access when dealing with a pneumorrhachis is the location of the entrapped air, as the clinical consequences of epidural pneumorrhachia and subarachnoid pneumorrhachis are different from each other. According to a previous case report, the rst is innocuous and self-limiting, while the second can be complicated by tension pneumocephalus and meningitis [2,8,12].…”

Section: Discussionmentioning

confidence: 98%

Symptomatic pneumorrhachis after arthrodesis due to gunshot wounds - A Case Report

Frenner¹,

Filho²,

Pokorny

et al. 2023

Preprint

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Introduction: Pneumorrhachis, is a condition where, air or gas, are entrapped within the spinal canal. Due to its rareness, it can present a diagnostic challenge. Usually, pneumorrhachis represents an asymptomatic epiphenomenon but it can produce symptoms associated with its underlying pathology. Here, we report a rare case of symptomatic epidural pneumorrhachis post arthrodesis in a patient with gunshot wounds to the thoracic spine. Possible pathogenic mechanisms are discussed, and a review of the literature is included. Case presentation: A 28-year-old male patient, victim of a gunshot wound receiving posterior spinal fixation without any intraoperative complication, presents with of intolerable and diffuse pain in the neck and back - making it impossible for him to remain in the supine position, epigastralgia and dysesthesia, especially in the upper limbs and right hemithorax, also reports loss of sensitivity to touch, especially in the distal extremities of the upper limbs. MRI exams shows clear presence of air (hypodense signal) in the treated thoracic region. A hyperbaric chamber was chosen, initially for five sessions, at the end of the five sessions, the patient only complained of dysesthesia and changes in distal fine motor skills, with almost complete recovery of strength. Five more sessions were performed, with total improvement of sensory changes and almost complete recovery of strength. Conclusion: Pneumorrhachis although usually asymptomatic can present in some cases several neurological impairments due to spinal cord compression.

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Section: Discussionmentioning

confidence: 98%

Symptomatic pneumorrhachis after arthrodesis due to gunshot wounds - A Case Report

Frenner¹,

Filho²,

Pokorny

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Further, another study reported that the occurrence of a delayed presentation of both pneumorrhachis and pneumocephalus due to the presence of CSF leak [11]. Finally, Bautista et al, 2021 reported the occurrence of a pneumorrhachis after a cervical spinal surgery procedure [12]. Although, the speci c cause of the air in ux into the canal are no very well stablished, the leading hypothesis is that it could occur after small dural injuries unperceived during the spinal procedure [12].…”

Section: Discussionmentioning

confidence: 99%

“…When presented with a symptomatic case of pneumorrhachis, the team must try to identify the possible causing agent, to remove it, or treat it with antibiotics, allied with hydration, bed-rest and correct positioning to avoid headaches and couching [12]. Another crucial factor to access when dealing with a pneumorrhachis is the location of the entrapped air, as the clinical consequences of epidural pneumorrhachia and subarachnoid pneumorrhachis are different from each other.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Symptomatic Pneumorrhachis After Arthrodesis Due to Gunshot Wounds—a Case Report

Fenner,

de Melo Filho,

Pokorny

et al. 2023

SN Compr. Clin. Med.

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Introduction:Pneumorrhachis, is a condition where, air or gas, are entrapped within the spinal canal. Due to its rareness, it can present a diagnostic challenge. Usually, pneumorrhachis represents an asymptomatic epiphenomenon but it can produce symptoms associated with its underlying pathology. Here, we report a rare case of symptomatic epidural pneumorrhachis post arthrodesis in a patient with gunshot wounds to the thoracic spine. Possible pathogenic mechanisms are discussed, and a review of the literature is included.Case presentation: A 28-year-old male patient, victim of a gunshot wound receiving posterior spinal xation without any intraoperative complication, presents with of intolerable and diffuse pain in the neck and back -making it impossible for him to remain in the supine position, epigastralgia and dysesthesia, especially in the upper limbs and right hemithorax, also reports loss of sensitivity to touch, especially in the distal extremities of the upper limbs. MRI exams shows clear presence of air (hypodense signal) in the treated thoracic region. A hyperbaric chamber was chosen, initially for ve sessions, at the end of the ve sessions, the patient only complained of dysesthesia and changes in distal ne motor skills, with almost complete recovery of strength. Five more sessions were performed, with total improvement of sensory changes and almost complete recovery of strength.Conclusion: Pneumorrhachis although usually asymptomatic can present in some cases several neurological impairments due to spinal cord compression.

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Symptomatic Pneumorrhachis from Bronchial-Subarachnoid Fistula

Lipinski,

Smith,

Wannamaker

et al. 2024

Diagnostics

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Bronchial-subarachnoid fistulas are rare occurrences, which are not well defined in the literature. This uncommon clinical phenomenon may result in symptomatic pneumorrhachis and presents unique clinical challenges. This report details a case of a 53-year-old female whose treatment for recurrent chondrosarcoma of the thoracic spine included multiple surgeries and radiotherapy. Two weeks after her most recent debulking surgery, she experienced a rapid onset of unusual symptoms, including headache, back and neck spasms, bladder incontinence, and confusion. The source of her symptoms was found to be secondary to pneumorrhachis from a pre-existing bronchial-pleural fistula that had fistulized to the subarachnoid space discovered on computed tomography (CT) and confirmed intraoperatively. The patient was treated successfully with high-flow oxygen therapy and bed rest, followed by surgical correction of both a pleural air leak and a dural defect with muscular flaps. The patient was discharged home in stable condition and remained clinically free of recurrent bronchial-subarachnoid fistula six months after surgical repair. This case contributes to the existing literature by providing detailed clinical insights into the diagnosis and successful management of a bronchial-subarachnoid fistula leading to pneumorrhachis, thereby highlighting the importance of early recognition and intervention and underscoring the need for further research in this area.

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Pneumorrhachis following cervical spine surgery

Cited by 3 publications

References 10 publications

Symptomatic pneumorrhachis after arthrodesis due to gunshot wounds - A Case Report

Symptomatic pneumorrhachis after arthrodesis due to gunshot wounds - A Case Report

Symptomatic Pneumorrhachis After Arthrodesis Due to Gunshot Wounds—a Case Report

Symptomatic Pneumorrhachis from Bronchial-Subarachnoid Fistula

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