The clinical significance of pneumorachis: A case report and review of the literature

BACKGROUND: Pneumorachis is a relatively rare phenomenon, where air enters the spinal canal. Because of its rarity, evaluation and management of this condition is poorly understood. This study describes a case of pneumorachis and performs a review of the current literature to understand the common causes, associated pathologies, presenting neurologic symptoms, treatment options, and neurologic outcomes for patients who develop pneumorachis. METHODS: The evaluation and management of a patient with pneumorachis who presented to our institution is described. In addition, a literature review of the Medline and Pubmed databases was conducted. The information collected from each study included the number of cases, proposed cause, associated findings, therapeutic interventions, and outcome. RESULTS: A total of 50 patients from 42 studies were identified. Pneumorachis typically occurred after injury to the respiratory system and was often associated with pneumothoraces, pneumomediastinum, and subcutaneous emphysema. This condition could also be seen after traumatic brain injury, especially with skull base and sinus fractures. Less common causes included primary spinal sources, visceral injuries, and fulminant infections. In most cases, pneumorachis was not associated with any spinal cord symptoms and typically resolved by addressing the underlying cause. CONCLUSION: This review demonstrates that intraspinal air is typically benign and resolves with conservative therapies. However, it should be realized that in a rare number of cases, pneumorachis can cause symptoms of cord compression and may even require decompressive surgery. Therefore, prompt evaluation and diagnosis remain important.