Epidural Pneumorrhachis Research Articles

Narrative review of traumatic pneumorrhachis.

Pneumorrhachis (PR) is defined as presence of free air in the spinal canal. Traumatic PR is very rare, and its exact incidence and pathogenesis is unknown. A comprehensive literature search was performed using the PubMed, Cochrane Library, Google Scholar and Scopus databases to identify articles relevant to traumatic PR published till January 2023. A total of 34 resources were selected for inclusion in this narrative review. Traumatic PR can be classified anatomically into epidural and intradural types. In the epidural type, air is present peripherally in the spinal canal and the patients are usually asymptomatic. In contrast, in intradural PR, air is seen centrally in the spinal canal and patients present with neurological symptoms, and it is a marker of severe trauma. It is frequently associated with traumatic pneumocephalus, skull fractures or thoracic spine fracture. Computed tomography (CT) is considered to be the diagnostic modality of choice. Epidural PR is self-limited and patients are generally managed conservatively. Patients with neurological symptoms or persistent air in spinal canal require further evaluation for a potential source of air leak, with a need for surgical intervention. Differentiation between epidural and intradural PR is important, because the latter is an indication of severe underlying injury. CT imaging of the entire spine must be performed to look for extension of air, as well as to identify concomitant skull, torso or spinal injuries Most patients are asymptomatic and are managed conservatively, but a few may develop neurological symptoms that need further evaluation and management.

Pneumorrhachis: A Rare Prognostic Lesson

Objective: We present a case of poly-traumatic epidural pneumorrhachis of an 87-year-old gentleman who had unremarkable neurology on presentation. We give an overview of aetiology and indications for intervention in pneumorrhachis. Background: Pneumorrhachis is the presence of air within the spinal canal, aetiologically it is widely variable though its observation in practice is rare. Methods: Descriptive. Results: We show figures illustrating CT images of pneumorrhachis at C3/4 level. The patient underwent progressive neurological deterioration over the course of four days on intensive care, and subsequently passed away. Conclusion: The presence of pneumorrhachis is well known to be associated with poor prognosis, and in our case predicted his subsequent neurological decline despite initial presentation. The presence of pneumorrhachis also serves as an important clue for hidden injuries.

Spontaneous epidural pneumorrhachis in 14 years old

Background: Pneumorrhachis is an exceedingly rare complication of pneumomediastinum as air tracks through tissue planes into the epidural (or subdural space). The majority of these patients present with a clear history of trauma, iatrogenic injury, pneumothorax, vomiting, or retching.Case Description: A 14-year-old male presented with the asymptomatic spontaneous onset of pneumorrhachis associated with significant pneumomediastinum of unclear etiology.Conclusion: Most patients with pneumorrhachis present with nonfocal neurological examinations. For these patients, it is critical to rule out infection as the cause of epidural gas. If other systemic signs are present, then urgent contrast-enhanced magnetic resonance imaging should be obtained. The majority of patients will demonstrate spontaneous radiographic resolution of pneumorrhachis within several days.

A CASE OF HAMMAN SYNDROME AND EPIDURAL PNEUMORRHACHIS IN THE SETTING OF METHAMPHETAMINE ABUSE

SESSION TITLE: Late-breaking Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Hamman’s syndrome can rarely coexist with pneumorrhachis when spontaneous collection of air in the mediastinum traverses through the fascial planes into the spinal canal. We report an unusual circumstance of Hamman’s syndrome developing into a pneumorrhachis in a patient after inhaled methamphetamine abuse. METHODS: A 20-year-old male presented after inhaling methamphetamine and developed severe bouts of cough and dyspnea. He also complained of neck pain that was sudden in onset and worsened with flexion and subsequent chest pain. Vitals on presentation were stable and swelling of his neck with subcutaneous crepitations in the jaw and chest were found on examination. Heart sounds were distant, but audible. Urine toxicology was positive for amphetamines. A chest x-ray revealed air around the upper mediastinum as well as periclavicular regions. A computer tomography (CT) scan showed the presence of subcutaneous emphysema and pneumomediastinum along with air column noted in the spinal canal, establishing a diagnosis of Hamman’s syndrome with pneumorrhachis. A gastrograffin study did not reveal esophageal tears or ruptures. During his admission, he was conservatively managed with serial chest x-rays showing gradual improvement in his subcutaneous emphysema. RESULTS: Hamman’s syndrome includes both subcutaneous emphysema and spontaneous pneumomediastinum (SPM). Risk factors such as coughing, vomiting and scuba diving, as well as systemic conditions such as asthma and cystic fibrosis can lead to an increase in intrathoracic pressure and alveolar rupture with dissection of air in the interstitial space, bronchovascular sheaths and subsequently to the mediastinum, also known as Macklin effect. Methamphetamine use can increase inflammatory markers such as tumor necrosis factor (TNF) alpha and IL-6, potentiating alveolar damage and risk of SPM. The combination of Hamman’s syndrome with pneumorrhachis is uncommon and occurs due to the passage of air between fascial planes from the posterior mediastinum into the neural foramina and epidural space. Examination of the patient includes auscultatory findings of pulmonary crackles synchronized with the heart sounds, known as Hamman’s sign. CT scan is considered as the gold standard imaging modality for diagnosis and anatomic localization. Treatment for uncomplicated SPM is supportive including analgesia, rest, treatment of underlying lung disease and avoidance of maneuvers that increase alveolar pressure. Surgical management is reserved for those who develop pneumorrhachis that is iatrogenic in nature or in the presence of complications such as hemodynamic instability and esophageal ruptures. CONCLUSIONS: We describe a unique case of symptomatic Hamman's syndrome and epidural pneumorrhachis secondary to methamphetamine use. CLINICAL IMPLICATIONS: Although uncommon, both these entities can be life-threatening and requires prompt evaluation and treatment. DISCLOSURES: No relevant relationships by Adhiraj Bhattacharya, source=Web Response No relevant relationships by Gahyun Gim, source=Web Response no disclosure on file for David Lee; No relevant relationships by Gemini Yesodharan, source=Web Response

Epidural pneumorrhachis consequent to Hamman syndrome.

Epidural pneumorrhachis consequent to Hamman syndrome.

Cauda Equina Syndrome Caused by Epidural Pneumorrhachis

A case report and review of the literature. To present a rare case, and its treatment, of cauda equina syndrome (CES) caused by epidural pneumorrhachis after repeated caudal epidural injections. Pneumorrhachis is defined as the presence of air in the epidural or subarachnoid space. Epidural pneumorrhachis is usually asymptomatic and managed conservatively, but rare cases of lumbar radiculopathy resulting from epidural air have been reported. To the best of our knowledge, there has been no previous report of CES caused by epidural air. A 63-year-old male presented with recent aggravation of a low backache, with pain radiating to both lower limbs. He also complained of newly developed numbness in the buttocks, groins, and perineum, and difficulty with urination and defecation, after repeated caudal epidural injections during a 3-week period. Computed tomography and magnetic resonance imaging revealed epidural pneumorrhachis compressing the lumbar dural sac at the L2-L3 and L3-L4 levels. The patient's symptoms persisted despite 3 days of oxygen inhalation therapy. Attempted needle aspiration of the epidural air was unsuccessful and percutaneous computed tomography-guided translaminar trephination was performed. The day after trephination, the patient's lower extremity motor strength began to improve; sphincter dysfunction began to resolve on the second day. During 8 weeks, his pain resolved and he gradually regained sensation. Two years later, the patient was free of symptoms or signs of CES. Epidural pneumorrhachis may cause dural sac compression, thus worsening a patient's previous symptoms and possibly eliciting new problems such as CES. Conservative treatment should be the first-line approach, but surgery is often necessary when the problem remains unsolved. Percutaneous computed tomography-guided translaminar trephination may be an alternative to surgical decompression of the epidural space in selected patients.

Symptomatic Epidural Pneumorrhachis : A Rare Entity

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.

Symptomatic Gas-Containing Herniated Disc With the Vacuum Phenomenon: Mechanism and Treatment

A 76-year-old woman presented with an extremely rare case of symptomatic gas-containing disc herniation manifesting as left posterolateral thigh pain and ankle dorsiflexion motor weakness. The diagnosis was L3-4 vacuum disc associated with epidural pneumorrhachis. The patient underwent partial hemilaminectomy and cyst incision. After incising the cyst, the thecal sac and root were decompressed sufficiently. Vacuum disc is a common phenomenon in the elderly rarely associated with pneumorrhachis and is usually asymptomatic. Symptomatic epidural gas-containing herniated discs with the vacuum phenomenon are very rare. Gas aspiration should be considered, but excision of the gas-containing herniated disc should be performed in patients with neurological deficits, frequent recurrence, or difficult location to approach.

Pneumorrhachis associated with bronchial asthma, subcutaneous emphysema, and pneumomediastinum

Pneumorrhachis is defined as the presence of air in the epidural space or subarachnoid space. The air may migrate along fascial planes from the posterior mediastinum, through the neural foramina, and into the epidural space. Pneumorrhachis is rare, and even more so in the paediatric population. Pneumorrhachis in itself usually is asymptomatic, does not tend to migrate and reabsorbs spontaneously. The combination of pneumomediastinum with epidural pneumorrhachis without thoracic trauma has rarely been reported in the literature. The present case report describes the presence of pneumomediastinum, subcutaneous emphysema, and pneumorrhachis in a child asthmatic patient who had a history of fever, violent cough.

Symptomatic Epidural Pneumorrhachis Associated With an Occult Pneumomediastinum Due to Minor Trauma

STUDY DESIGN.: A case report and review of the literature. OBJECTIVE.: To discuss the significance of identifying symptomatic epidural pneumorrhachis associated with an occult pneumomediastinum in the absence of pneumothorax and subcutaneous emphysema after minor trauma. SUMMARY OF BACKGROUND DATA.: Pneumorrhachis is defined as the presence of air in the epidural space or subarachnoid space. Previous reports have suggested that traumatic epidural pneumorrhachis was usually asymptomatic and a combination of pneumothorax, pneumomediastinum, and subcutaneous emphysema following major trauma and managed by conservative treatment. METHODS.: A 53-year-old man was admitted to the emergency department after the traffic collision. He presented with diffuse pain ranging from the neck to back, and complained of radiating shoulder pain. RESULTS.: The lateral cervical spine radiograph revealed an air shadow in the anterior cervical space. Axial image of cervical spine computed tomography (CT) revealed epidural pneumorrhachis. The sagittal reconstruction image of neck CT showed a small amount of air in the posterior mediastinum, and scattered air in the anterior cervical spinal canal. Our patient was treated conservatively and had a complete and uneventful recovery. CONCLUSION.: To our knowledge, this is the first case in which symptomatic traumatic epidural pneumorrhachis was associated with an occult pneumomediastinum in the absence of pneumothorax and subcutaneous emphysema. These findings may be useful in alerting trauma specialists to carefully evaluate the associated pathologies leading to pneumorrhachis enabling adequate therapy.