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

Abstract

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.