Symptomatic Pneumorrhachis

Abstract

Pneumorrhachis (PR) is the presence of air within the spinal canal, whether localized in the epidural or in the subarachnoid space. Evidence of intraspinal air, especially in the subarachnoid space, had been thought to be merely a radiological artifact of serious underlying pathology until it was proven that PRs can be related to neurologic symptoms ranging from radicular pain to serious neurologic deficits. The etiologies, pathomechanisms, and natural courses show differences from case to case, with the result that no consistent treatment strategies exist in the literature. Although the conservative treatment modalities seem to be more appropriate in nonsymptomatic cases, treatment strategies in symptomatic cases remain the subject of discussion. In this study, we present two symptomatic cases of PR arising from different causes and review the literature, focusing especially on the symptomatic cases and strategies for treating them.

Traumatic pneumocephalus as a possible early sign of acute spinal cord injury: Case report

“…It can be caused by air migrating from the spinal canal to the intracranial compartments and, therefore, be a secondary manifestation of traumatic PR [15] . TPC in trauma can coexist with PR, in the presence or absence of underlying craniofacial fractures [8] , [9] – 10] . The diagnosis of SCI in polytrauma patients with TPC may be elusive when there are no evident craniofacial or other grossly unstable spinal fractures.…”

“…As this is an extremely rare phenomenon, there is no current diagnostic algorithm for identifying those polytrauma patients with TPC or PR which may be at high risk of SCI and, therefore, may deserve early MRI imaging [8] , [9] – 10] . Assessing for clinical signs of SCI may be challenging in polytrauma patients, especially in the presence of pelvic or lower extremity fractures, or overt shock.…”

“…TPC can also be caused by air entering intracranially through the sinuses, mastoid, or other aerated air cells [4] , [5] , [6] – 7] . TPC in the absence of craniofacial fractures is a much rarer occurrence and has been reported as a possible consequence of upward gas migration from the spinal canal [8] , [9] – 10] .…”

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

“…Occurrence of pneumorrhachis is frequently asymptomatic and does not require any speci c treatment because air is reabsorbed spontaneously without leaving any neurological sequela [4,7]. The onset of symptoms in pneumorrhachis cases are very rare, however when they occur it could causa discomfort and/or pain, and even neurological de cits [7][8][9].…”

Pneumorrhachis and pneumocephalus resulting from pneumothorax: illustrative case

“… 1 PR self-resolves in most cases and is managed conservatively with bed rest, neurological symptom monitoring, and oxygen therapy. 1 , 10 , 14 , 15 However, PR, especially intradural PR, should prompt clinicians to find and treat any underlying cause. 10 …”