J Korean Neurosurg Soc.  2013 Jul;54(1):65-67. 10.3340/jkns.2013.54.1.65.

Symptomatic Epidural Pneumorrhachis : A Rare Entity

• Kim SW
• Seo HJ

• KMID: 2190863
• DOI: http://doi.org/10.3340/jkns.2013.54.1.65

Abstract

Pneumorrhachis, which involves the entrapment of air or gas within the spinal canal, is a rare clinical entity, and the pathogenesis and etiologies of this uncommon entity are various and 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 accompanying pneumothorax. Possible pathogenic mechanisms are discussed and a review of the literature is included.

Keyword

Trauma; Pneumorrhachis

MeSH Terms

Pneumorrhachis
Pneumothorax
Spinal Canal

Figure

• 

  Fig. 1 Computed tomography (CT) scans of the patient. A and B : Sagittal and axial cervicothoracic CT images show air (arrows) within the anterior cervical epidural space. C and D : Sagittal and axial cervicothoracic CT images show air (arrows) within the posterior thoracic epidural space.

• 

  Fig. 2 The CT scan obtained on the fourteenth hospital day demonstrates complete resolution of the epidural pneumorrhachis.

Reference

1. Adams MT, Nadalo L, Dunn EL. Air in the spinal canal following blunt thoracic trauma. J Trauma. 2003; 55:386. PMID: 12913657.

2. Akay S, Bayram B. Traumatic pneumorrhachis : a rare entity of trauma. Int J Emerg Med. 2008; 1:53. PMID: 19384503.

3. Aribas OK, Gormus N, Aydogdu Kiresi D. Epidural emphysema associated with primary spontaneous pneumothorax. Eur J Cardiothorac Surg. 2001; 20:645–646. PMID: 11509299.

4. Cayli SR, Koçak A, Kutlu R, Tekiner A. Spinal pneumorrhachis. Br J Neurosurg. 2003; 17:72–74. PMID: 12779206.

5. Chibbaro S, Selem M, Tacconi L. Cervicothoracolumbar pneumorachis. Case report and review of the literature. Surg Neurol. 2005; 64:80–82. PMID: 15993195.

6. Fardon DF, Simmons JD. Gas-filled intraspinal synovial cyst. A case report. Spine (Phila Pa 1976). 1989; 14:127–129. PMID: 2913661.

7. Goh BK, Yeo AW. Traumatic pneumorrhachis. J Trauma. 2005; 58:875–879. PMID: 15824674.

8. Kapur A, Sandhu S. Epidural pneumatosis : not necessarily benign. AJNR Am J Neuroradiol. 1994; 15:195–196. PMID: 8141057.

9. Kim CH. Pneumorrhachis and paraspinal air with vacuum disc : case report and literature review. J Korean Neurosurg Soc. 2007; 42:490–491. PMID: 19096597.

10. Koelliker PD, Brannam LA. Epidural pneumatosis associated with spontaneous pneumomediastinum : case report and review of the literature. J Emerg Med. 1999; 17:247–250. PMID: 10195480.

11. Scialdone CJ, Wagle W. Intraspinal air : an unusual manifestation of blunt chest trauma. Clin Imaging. 1990; 14:59–60. PMID: 2322885.

12. Uemura K, Behr R, Roosen K. Symptomatic intraspinal air entrapment. Br J Neurosurg. 2000; 14:154–156. PMID: 10889894.