Intraspinal Gas Research Articles

Intraforaminal cervical gas cyst with vacuum disc treated by anterior cervical discectomy and fusion: illustrative case.

BACKGROUNDThe authors report an extremely rare presentation of a patient with an intraforaminal cervical gas cyst with radiculopathy. The patient’s condition was refractory to conservative treatment, and he was treated by anterior cervical discectomy and fusion (ACDF). Several intraspinal gas cysts with lumbar disc herniation have been treated surgically. However, no cases of intraforaminal cervical gas requiring ACDF have been reported.OBSERVATIONSA 70-year-old male patient presented with right-sided neck and shoulder pain, aggravating in the supine position. Cervical radiography showed vacuum disc phenomenon at C4–5, and multiplanar computed tomography showed intraforaminal gas along the right C5 nerve root. The patient experienced severe pain with impaired sleep and daytime fatigue. After confirming C5 radiculopathy using an echo-guided technique using ultrasonography guidance, the authors performed C4–5 ACDF. Postoperatively, the patient’s neck and shoulder pain disappeared immediately. There was no recurrence at the 2-year follow-up.LESSONSThis is the first case report of an intraspinal cervical gas cyst with radiculopathy treated by ACDF surgery. The vacuum disc had been implicated as the genesis of the intraforaminal cervical gas cyst, leading to radiculopathy. ACDF surgery provides favorable outcomes in cases of intraspinal gas refractory to conservative therapy.

Hemopneumothorax associated with pneumorrachis following blunt chest trauma

Pneumorrhacis is a condition marked by the presence of air in the spinal canal. We present a rare case of pneumorrachis of the cervical to thoracic canal associated with hemopneumothorax and flail chest with subcutaneous emphysema that recovered remarkably after shaft clipping surgery and chest tube insertion only. Pneumorrachis can resolve by itself with conservative management. A 45-year-old woman suffered from chest pain and shortness of breath after fell at the hotel swimming pool. Further examination revealed rhonchi on left lung auscultation and asymmetry respiratory pattern. Computed tomography of the chest proved the presence of multiple rib fractures 4-9 left side, hemopneumothorax, subcutaneous emphysema. Accidentally, the CT showed intraspinal gas representing pneumorrachis extending from C6-T3. No neurologic deficit was found. She was treated conservative by supplemental oxygen only, no further neurological deterioration was detected. Follow up examination was uneventful and the symptoms resolved completely. Pneumorrachis was mostly found accidentally with a variety of underlying diseases, especially in the case of traumatic pneumothorax and fracture of the skull base. Pneumorrachis was managed conservatively and should be taken in attention in the presence of neurologic deficits.

Nerve root compression caused by intraspinal gas accumulation. A case report

Vacuum disc phenomenon is a condition frequently seen with degenerative disc disease and is characterized by the collection of gas in the disc space. In rare cases, gas accumulation can spread into the intraspinal canal. When it occurs, clinical symptoms may be observed. We present a case report of S1 nerve root compression caused by intraspinal gas accumulation.Diagnosis of the disease was complicated by the fact that magnetic resonance imaging had not revealed intraspinal gas accumulation. The diagnosis was confirmed only by computed tomography findings.

Dura sac compression due to spinal epidural gas pseudocyst after lumbar decompression surgery: a case report

BackgroundIntraspinal gas pseudocyst is rare, especially following spinal surgery. Here we present a case of spinal epidural gas pseudocyst following lumbar decompression surgery, which caused dura sac compression.Case presentationA 52-years-old woman with chronic lumbar pain and radiating numbness of left leg was admitted to our hospital and underwent a posterior lumbar decompression surgery. 10 days later, the patient began to have dysfunction of excretion. CT and MRI were taken and epidural gas was detected, which compressed the dura sac. A huge pseudocyst encapsulated with high-tension air was found during debridement with no evidence of infection.ResultsDebridement surgery was taken to remove the encapsulated gas and cyst wall and her symptoms disappeared soon after the surgery. 2 weeks later, routine X-ray was repeated and gas pseudocyst disappeared with no signs of infection.ConclusionGas pseudocyst in the spinal canal is rare, especially after lumbar surgery and causing spinal cord compression. CT and MRI can be used to detect the spinal gas. Once gas pseudocyst causes dura sac compression, proper methods should be chosen to treat this kind of intraspinal gas pseudocyst.

Disc Herniation and Cyst Gas: A Rare Association Causing Radicular Compression

Introduction Intraspinal gas is a common clinical finding, but an epidural gas pseudocyst in association with lateral disc herniation compressing a nerve root is an exceptional observation. Case Report A 49-year-old man was admitted to our department presenting with sciatica. The neurological examination demonstrated moderate lumbar pain without neurological deficit. A lumbosacral computed tomography showed the presence of degenerated disc herniation and epidural gas collection. Discussion The pathological association between the cyst and the hernia is probably due to the migration of gas pumped from the intervertebral space through a breaking point or lower in the annulus fibrosis, involving its contiguity with the herniated disc. Conclusion An association between a disc herniation and a gas pseudocyst can be a cause of sciatica.

Transforaminal Endoscopic Decompression for a Giant Epidural Gas-Containing Pseudocyst: A Case Report and Literature Review

The isolated epidural gas-containing pseudocyst is an uncommon pathogenic factor for severe pain of the lower limb as a result of nerve root compression. After reviewing these rare cases reported in the literature, we found that the name, pathogenesis, and treatment strategy of this pathology remained controversial. The most common treatment is conservative treatment or percutaneous aspiration which might result in poor pain relief and high recurrence rates. Moreover, the patient who received open surgery had good clinical outcome; however, he or she might experience a significant soft tissue injury. In this study, we report the first case of a patient who had a giant epidural gas-containing pseudocyst and received percutaneous endoscopic surgery. This 57-year-old man had been complaining of severe radicular pain in his right ankle for one year. According to computed tomography (CT) and magnetic resonance imaging (MRI) prior to the surgery, the results showed an isolated epidural gas-containing pseudocyst was located in the right lateral recess of S1. At the last follow-up period, postoperative CT scan showed the gas-contained pseudocyst was completely resected and this patient was free from the pain. Due to the great advances in endoscopic techniques and equipment, it is easier to perform lumbar surgery through the endoscope. With this first case of percutaneous endoscopic treatment for the symptomatic epidural gas-containing pseudocyst reported in this study, we believe that this surgical method provides an option to treat this rare condition because it provides sufficient decompression, has a low recurrence rate, and is minimally invasive. Key words: Endoscopic surgery, pseudocyst, epidural gas, intraspinal gas, radiulopathy

Scary gas: intravascular, intracranial, and intraspinal ectopic gas (part III).

While ectopic gas can be a sign of dangerous disease requiring immediate medical or surgical intervention, it can also be an incidental and benign finding. Intravenous gas and spinal vacuum gas are common and almost always benign. Intravascular gas is most often related to instrumentation and, if intraarticular, can cause end-organ ischemia; however, treatment is usually supportive. Pneumocephalus arises from a communication with paranasal sinuses or mastoids more often than from meningeal infection and can usually be managed nonoperatively. In part 3 of this series, the different causes of ectopic gas in the vessels, skull, and spine are reviewed, as are the imaging features that can help to narrow the differential diagnosis.

Intraspinal gas pseudocyst

Intraspinal gas pseudocyst

Posttraumatic intradural pneumorrhachis: A rare entity

Pneumorrhachis, denoting intra-spinal air, is an uncommon epiphenomenon of coincident underlying injuries and diseases, accompanied by different aetiologies and possible pathways of air entry into the spinal canal. Air within the spinal canal can be divided into primary and secondary pneumorrhachis, extra- or intradural pneumorrhachis and aetiologically subsumed into iatrogenic, traumatic and nontraumatic The pathogenesis and aetiologies of pneumorrhachis are multifold and can be a diagnostic challenge. CT is the imaging tool of choice. Pneumorrhachis has to be differentiated from free intraspinal gas collections and the coexistence of air and gas within the spinal canal has to be considered differential diagnostically. Pneumorrhachis usually is asymptomatic but can also be symptomatic by itself as well as by its underlying pathology. The latter, although often severe, might be concealed and has to be examined carefully to enable adequate patient treatment. The management of pneumorrhachis has to be individualized.

Symptomatic Epidural Gas Cyst Associated With Discal Vacuum Phenomenon

Four cases of computed tomography and magnetic resonance imaging documented lumbar nerve root compression associated with a vacuum disc communicating with the epidural space are presented. To give an insight into the mechanism of nerve root compression associated with vacuum disc phenomenon. Few cases of lumbar radiculopathy resulting from epidural gas have been reported and illustrated using cross-sectional imaging studies. The medical records, imaging examinations, and surgical findings (when available) of 4 symptomatic patients with epidural and intradiscal gas collections were reviewed. Three patients underwent surgery with needle aspiration of the epidural gas, and 1 patient was treated conservatively. Clinical symptoms of epidural gas cyst were similar to those of other more common causes of nerve root compression. Computed tomography and magnetic resonance imaging findings showed intraspinal gas collection associated with a vacuum disc. One patient had an additional vertebral pneumatocyst. Although evacuation of intraspinal gas resulted in complete cure or major neurologic improvement in 3 patients, an initial period of observation is warranted because gas may disappear spontaneously as in 1 of our patients. All 4 patients recovered full motor and sensory functions of the lower extremities. One year later, patients were completely free of symptoms. Although the vacuum disc is considered a common imaging finding of no or not much pathologic significance, occasionally intradiscal gas may leak into the spinal canal. Detection of an epidural gaseous collection at the same level with a vacuum disc strongly suggests a communication between the intervertebral disc and the epidural space. Epidural gas collections can be implicated as a possible cause of radicular symptoms and should be considered in the differential diagnosis of lumbar radiculopathy.

Spinal epidural air after severe pelvic and abdominal trauma

Air in the lumbar spinal canal after trauma is uncommon. However, it can be observed in a number of pathologic settings including tumor, infection, degenerative disk disease, and in patients who have undergone therapeutic and diagnostic procedures. Intraspinal gas is usually asymptomatic. We report a case of a motorcycle accident resulting in a complex open pelvic and multiple long bone fractures. Air was discovered within the spinal canal between levels L3 and L5 on a computed tomographic scan. This case provides further evidence that intraspinal air may remain without symptoms and that possible resultant symptoms and the air can disappear spontaneously.

Intraspinal gas

Intraspinal gas can be observed in a number of pathological settings including degenerative disc disease, infection, tumor or trauma, and in patients who have undergone therapeutic and diagnostic procedures. The air can be epidural, intradural or intradiscal. Intraspinal gas is usually asymptomatic. We report intraspinal gas in three patients, one with cervical, one with thoracic, and one with lumber disc disease and spondylolisthesis. The investigations were all completed at the the same medical center and CT and MRI were done in each case. The gas was in the epidural space in all three patients. These cases provide further evidence that intraspinal gas may persist without causing symptoms, and that resultant symptoms can disappear spontaneously. MRI is not reliable for diagnosing intraspinal gas; CT is recommended.

Pathogenesis, diagnosis and management of pneumorrhachis

Pneumorrhachis (PR), the presence of intraspinal air, is an exceptional but eminent radiographic finding, accompanied by different aetiologies and possible pathways of air entry into the spinal canal. By reviewing the literature and analysing a personal case of traumatic cervical PR after head injury, we present current data regarding the pathoanatomy, clinical and radiological presentation, diagnosis and differential diagnosis and treatment modalities of patients with PR and associated pathologies to highlight this uncommon phenomenon and outline aetiology-based guidelines for the practical management of PR. Air within the spinal canal can be divided into primary and secondary PR, descriptively classified into extra- or intradural PR and aetiologically subsumed into iatrogenic, traumatic and nontraumatic PR. Intraspinal air is usually found isolated not only in the cervical, thoracic and, less frequently, the lumbosacral regions but can also be located in the entire spinal canal. PR is almost exceptional associated with further air distributions in the body. The pathogenesis and aetiologies of PR are multifold and can be a diagnostic challenge. The diagnostic procedure should include spinal CT, the imaging tool of choice. PR has to be differentiated from free intraspinal gas collections and the coexistence of air and gas within the spinal canal has to be considered differential diagnostically. PR usually represents an asymptomatic epiphenomenon but can also be symptomatic by itself as well as by its underlying pathology. The latter, although often severe, might be concealed and has to be examined carefully to enable adequate patient treatment. The management of PR has to be individualized and frequently requires a multidisciplinary regime.

Recurrent sciatica due to periligamentous trapped epidural gas after spinal sequestrectomy

The authors describe the unusual case of a 50-year-old woman who suffered from sciatic pain due to periligamentous trapped epidural gas after lumbar sequestrectomy. The patient underwent removal of free herniated disc material via a translaminar approach through the L-5 lamina without discectomy. Four days later she suffered from recurrent pain, and neuroimaging studies revealed an epidural gas formation at the site of the sequestrectomy. After evacuation of the gas, her pain resolved. Postoperative intraspinal gas may be symptomatic in the rare case.

Two cases of radicular compression due to lumbar intraspinal gas cyst

Two cases of radicular compression due to lumbar intraspinal gas cyst

Intraspinal Gas with Lumberjack Injury - A Case Report -

Intraspinal Gas with Lumberjack Injury - A Case Report -

Lumbar radiculopathy and intraspinal gas

Gas within the spinal canal is uncommon and has been associated with trauma, infection and disc degeneration and vacuum phenomenon. We report a 73-year-old man with a history of intermittent low back pain who developed sharp low back pain with radiation to the left calf and ankle when ambulating or standing. Relief was obtained with sitting or lying down, which led to the clinical impression of spinal stenosis. The neuromuscular exam was unremarkable and no sciatic nerve tension sign was present. Electrodiagnostic studies were consistent with an acute S1 radiculopathy, while a dermatomal somatosensory evoked potential was interpreted as essentially normal. A CT scan showed gas in the left lateral spinal canal at L4-S1. After 2 weeks, spontaneous improvement occurred and the patient resumed normal activities. A repeat CT scan after 0.5 years showed the intraspinal gas was diminished while the L5-S1 disc vacuum phenomenon had worsened and a right disc extrusion occurred. The natural history of intraspinal gas, disc vacuum phenomenon and related complications are discussed.

Intraspinal gas associated with intestinal necrosis detected by CT

We report the case of a 63-year-old woman with necrosis of the small intestine and intraspinal collections of gas, which were detected using computed tomography (CT). Abdominal CT revealed extensive collections of gas in the portal and mesenteric veins and within the intestinal walls. Gas radiolucencies were also noted in the epidural spaces of her spine. This gas was considered to have migrated from the pelvic venous system into the internal venous plexus of the spine. Intestinal necrosis should be included in the differential diagnosis of intraspinal gas collections during CT.

Spinal magnetic resonance imaging immediately after craniotomy for detection of metastatic disease.

Although magnetic resonance imaging (MRI) may be more sensitive than myelography with CT scanning in detecting spinal metastatic disease (SMD), the limitations of these MRI examinations have not been defined. The feasibility of obtaining early postoperative MRI to screen for SMD, and the type and frequency of imaging abnormalities were evaluated in this prospective study. Twenty-seven patients (78% with nondisseminating neoplasms or nonneoplastic diseases) were studied with postoperative spinal MRI without and with contrast enhancement, obtained within 24 h of craniotomy. Procedural problems with immediate spinal MRI were identified. Physician monitoring of the examination did not guarantee an adequate examination, and small abnormalities were missed or incompletely evaluated at the time of the MRI. Surprisingly, abnormal signal from intraspinal gas, blood, or blood breakdown products was not seen. In the absence of metastatic disease, spinal meningeal enhancement was absent. True SMD was detected, but nonneoplastic focal contrast enhancement (false positive) occurred in 11%. An unusual nonneoplastic subdural cerebrospinal fluid enhancement was seen in 3 of 13 (23%) of all patients undergoing posterior fossa craniectomies. This enhancement could hide small metastases or could be confused for SMD. Although immediate postoperative spinal MRI is potentially effective as a screening tool for the detection of SMD, we have identified some significant limitations of this technique.

Disc herniation with gas.

Intradiscal gas is associated with tumors, infection, trauma, therapeutic and diagnostic spinal procedures, deposit illnesses, and disc degeneration. The existence of gas within the spinal canal has been seen on 17 occasions, of which 13 were associated with discal hernias. In this study, 19 additional patients with intraspinal gas corresponding to discal hernias are presented, six of whom required surgical treatment. The association of intraspinal gas with intradural hernias frequently is reported in the literature, although this has not been proven in our group. Intrahernial gas is associated with patients who have chronic problems and with advanced age. Intrahernial gas is much more common than is indicated in the literature. This finding often goes unnoticed, and the association between intradiscal gas and intradural hernias should be kept in mind.