J Neurol Surg A Cent Eur Neurosurg 2014; 75(02): 140-145
DOI: 10.1055/s-0032-1333123
Review
Georg Thieme Verlag KG Stuttgart · New York

Symptomatic Pneumorrhachis

Ender Koktekir
1   Department of Neurosurgery, Selcuk University, Selcuklu Medical School, Konya, Turkey
,
Necati Tatarli
2   Department of Neurosurgery, Dr. Lutfi Kirdar Education and Research Hospital, Istanbul, Turkey
,
Davut Ceylan
3   Department of Neurosurgery, Sakarya University, Sakarya, Turkey
,
Bengu Ekinci Koktekir
4   Department of Ophthalmology Selcuk University, Selcuklu Medical School, Konya, Turkey
,
Gokhan Akdemir
1   Department of Neurosurgery, Selcuk University, Selcuklu Medical School, Konya, Turkey
› Author Affiliations
Further Information

Publication History

17 June 2012

11 August 2012

Publication Date:
20 February 2013 (online)

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.

 
  • References

  • 1 Chaichana KL, Pradilla G, Witham TF, Gokaslan ZL, Bydon A. The clinical significance of pneumorachis: a case report and review of the literature. J Trauma 2010; 68: 736-744
  • 2 Kapur A, Sandhu S. Epidural pneumatosis: not necessarily benign. AJNR Am J Neuroradiol 1994; 15: 195-196
  • 3 Oertel MF, Korinth MC, Reinges MHT, Gilsbach JM. Pneumorrhachis of the entire spinal canal. J Neurol Neurosurg Psychiatry 2005; 76: 1036
  • 4 Gordon IJ, Hardman DR. The traumatic pneumomyelogram. A previously undescribed entity. Neuroradiology 1977; 13: 107-108
  • 5 Chibbaro S, Selem M, Tacconi L. Cervicothoracolumbar pneumorachis. Case report and review of the literature. Surg Neurol 2005; 64: 80-82
  • 6 Tambe P, Kasat LS, Tambe AP. Epidural emphysema associated with subcutaneous emphysema following foreign body in the airway. Pediatr Surg Int 2005; 21: 721-722
  • 7 Newbold RG, Wiener MD, Vogler III JB, Martinez S. Traumatic pneumorrhachis. AJR Am J Roentgenol 1987; 148: 615-616
  • 8 Oertel MF, Korinth MC, Reinges MH, Krings T, Terbeck S, Gilsbach JM. Pathogenesis, diagnosis and management of pneumorrhachis. Eur Spine J 2006; 15 (Suppl. 05) 636-643
  • 9 Sinha PA, Mantle M. Cervical pneumorrhachis. Clin Radiol 2000; 55: 569-570
  • 10 Rehman TA, Mammen T, Thaj J, Cherian RS. Is pneumorrhachis a poor prognostic sign in acute gangrenous abdominal emergencies?. Emerg Radiol 2009; 16: 151-154
  • 11 Sandhya P, Keshava SN, Danda D, Padhan P, Mathew J, Gibikote S. Pneumorrhachis and pneumomediastinum in connective tissue disease-related interstitial lung disease: case series from a tertiary care teaching hospital in South India. Rheumatol Int 2012; 32: 1415-1419
  • 12 Karaoglan A, Cal MA, Orki A, Arpaozu BM, Colak A. Pneumorrhachis associated with bronchial asthma, subcutaneous emphysema and pneumomediastinum. Turk Neurosurg 2011; 21: 666-668
  • 13 Neve M, Naudin J, Sachs P, Dauger S. Pneumorrhachis in a 2-month-old after an accidental gunshot injury. J Pediatr 2011; 159: 163
  • 14 Wośko J, Dabrowski W, Zadora P, Fijalkowska A, Grzycka-Kowalczyk L. [Pneumocephalus and pneumorrhachis after chest wall injury]. Anestezjol Intens Ter 2011; 43: 40-44
  • 15 Cayli SR, Koçak A, Kutlu R, Tekiner A. Spinal pneumorrhachis. Br J Neurosurg 2003; 17: 72-74
  • 16 Goh BKP, Yeo AWY. Traumatic pneumorrhachis. J Trauma 2005; 58: 875-879
  • 17 Son S, Kang DH, Choi DS, Choi NC. A case of broncho-paraspinal fistula induced by metallic devices: delayed complication of thoracic spinal surgery. J Korean Neurosurg Soc 2011; 50: 64-67
  • 18 Miguel R, Morse S, Murtagh R. Epidural air associated with multiradicular syndrome. Anesth Analg 1991; 73: 92-94
  • 19 Rovlias A, Pavlakis E, Kotsou S. Symptomatic pneumorachis associated with incidental durotomy during microscopic lumbar disc surgery. Case report. J Neurosurg Spine 2006; 5: 165-167
  • 20 Ould-Slimane M, Ettori MA, Lazennec JY, Pascal-Moussellard H, Catonne Y, Rousseau MA. Pneumorachis: a possible source of traumatic cord compression. Orthop Traumatol Surg Res 2010; 96: 825-828
  • 21 Chimon JL, Cantos EL. CT recognition of spinal epidural air after pelvic trauma. J Comput Assist Tomogr 1990; 14: 795-796
  • 22 Abraham DJ, Vaccaro AR, Albert TJ, Cotler JM. Gas in the spinal canal associated with injury of the cervical spinal cord: a diagnostic dilemma. A case report. J Bone Joint Surg Am 1997; 79: 591-593
  • 23 Gelalis ID, Karageorgos A, Arnaoutoglou C , et al. Traumatic pneumorrhachis: etiology, pathomechanism, diagnosis, and treatment. Spine J 2011; 11: 153-157
  • 24 McCall CS, Nguyen TQ, Vines FS, Bremer AM. Pneumocephalus secondary to tension pneumothorax associated with comminuted fracture of the thoracic spine. Neurosurgery 1986; 19: 120-122
  • 25 Arora S, Aggarwal P, Cheema GS, Singla J. Pneumorachis of the cervical spine with associated pneumocephalus and subcutaneous emphysema. Indian J Orthop 2011; 45: 372-375
  • 26 Gonzales GR, Payne R, Portenoy RK, Foley KM. Epidural air from a bronchopleural-epidural-cutaneous fistula producing reversible myelopathy and radiculopathy symptoms. Neurology 1994; 44: 2409-2410
  • 27 Lerner EJ, Bilaniuk LT. Spontaneous bronchial-subarachnoid fistula: an unusual cause of pneumocephalus. AJNR Am J Neuroradiol 1989; 10 (5 Suppl): S103
  • 28 Oertel MF, Gilbach JM. Answer to the letter to the editor: “A case of cervical pneumorrhachis induced by the combination of pneumomediastinum and root avulsion injuries” concerning “Pathogenesis, diagnosis and management of pneumorrhachis” (by M. Oertel et al.). Eur Spine J 2007; 16: 575
  • 29 Derner M, Drugová B, Hořejší L, Skvára D, Druga R. Massive pneumorrhachis, pneumocephalus and pneumoopticus following thoracic trauma and avulsion of the brachial plexus: case report and review of the literature. Prague Med Rep 2011; 112: 56-66
  • 30 Gracia J, Gomar C, Riambau V, Cardenal C. Radicular acute pain after epidural anaesthesia with the technique of loss of resistance with normal saline solution. Anaesthesia 1999; 54: 168-171
  • 31 Hirsch M, Katz Y, Sasson A. Spinal cord compression by unusual epidural air accumulation after continuous epidural analgesia. AJR Am J Roentgenol 1989; 153: 887-888
  • 32 Kennedy TM, Ullman DA, Harte FA, Saberski LR, Greenhouse BB. Lumbar root compression secondary to epidural air. Anesth Analg 1988; 67: 1184-1186
  • 33 Krishnam MA, Mallick A. Air in the epidural space leading to a neurological deficit. Anaesthesia 2003; 58: 292-293
  • 34 Lin LC, Liao YM, Yang RC. Pneumorrhachis following lumbar puncture: a case report. Kaohsiung J Med Sci 2006; 22: 39-43
  • 35 Nay PG, Milaszkiewicz R, Jothilingam S. Extradural air as a cause of paraplegia following lumbar analgesia. Anaesthesia 1993; 48: 402-404
  • 36 Overdiek N, Grisales DA, Gravenstein D, Bosek V, Nishman R, Modell JH. Subdural air collection: a likely source of radicular pain after lumbar epidural. J Clin Anesth 2001; 13: 392-397
  • 37 Chun BJ, Moon JM. Symptomatic epidural pneumorrhachis associated with an occult pneumomediastinum due to minor trauma. Spine 2009; 34: E979-E982
  • 38 Park JS, Kim H, Lee SW, Min JH, Kim SW, Lee KW. Symptomatic pneumorrhachis after chest tube insertion for spontaneous pneumothorax. Am J Emerg Med 2010; 28: 846-2 , e1–e2
  • 39 Ristagno RL, Hiratzka LF, Rost Jr RC. An unusual case of pneumorrhachis following resection of lung carcinoma. Chest 2002; 121: 1712-1714
  • 40 Prabhakar H, Bithal PK, Ghosh I, Dash HH. Pneumorrhachis presenting as quadriplegia following surgery in the prone position. Br J Anaesth 2006; 97: 901-903
  • 41 Yousaf I, Flynn P, McConnell R. Symptomatic intraspinal pneumocoele resulting from closed head injury. Br J Neurosurg 2003; 17: 248-249
  • 42 Uemura K, Behr R, Roosen K. Symptomatic intraspinal air entrapment. Br J Neurosurg 2000; 14: 154-156
  • 43 Harrod CC, Boykin RE, Kim YJ. Epidural pneumatosis of the cervicothoracic spine associated with transient upper motor neuron findings complicating Haemophilus influenzae pharyngitis, bronchitis, and mediastinitis. J Pediatr Orthop 2010; 30: 455-459
  • 44 Song KJ, Lee KB. Spontaneous extradural pneumorrhachis causing cervical myelopathy. Spine J 2009; 9: e16-e18