Pneumorrhachis

Last revised by Frank Gaillard on 14 Apr 2024

Citation, DOI, disclosures and article data

Citation:

Weerakkody Y, Gaillard F, Niknejad M, et al. Pneumorrhachis. Reference article, Radiopaedia.org (Accessed on 16 Apr 2024) https://doi.org/10.53347/rID-10875

DOI:

https://doi.org/10.53347/rID-10875

Permalink:

https://radiopaedia.org/articles/10875?iframe=true

rID:

10875

Article created:

29 Sep 2010, Yuranga Weerakkody ◉

Disclosures:

At the time the article was created Yuranga Weerakkody had no recorded disclosures.

View Yuranga Weerakkody's current disclosures

Last revised:

14 Apr 2024, Frank Gaillard ◉ ◈

Disclosures:

At the time the article was last revised Frank Gaillard had no financial relationships to ineligible companies to disclose.

View Frank Gaillard's current disclosures

Revisions:

27 times, by 15 contributors - see full revision history and disclosures

Systems:

Central Nervous System, Musculoskeletal, Spine, Trauma

Tags:

emergency medicine

Synonyms:

Traumatic pneumorrhachis
Intraspinal air
Epidural pneumatosis
Aerorachia
Epidural emphysema
Pneumorachis

Pneumorrhachis refers to the presence of gas within the spinal canal (either intra- or extradural). It is rare.

trauma (traumatic pneumorrhachis): can occur in a variety of traumatic settings
- traumatic pneumothorax
- blunt chest trauma ⁵
  - subarachnoid-pleural fistula
- skull fracture
- iatrogenic / post surgical
  - epidural anesthesia
  - thoracic / lumbar surgery
non-traumatic
- spontaneous pneumomediastinum (e.g. from bronchial asthma, Hamman syndrome)
- regional necrotizing fasciitis (rare)
- marijuana smoking
- cocaine snorting¹¹

Treatment and prognosis

Patients with pneumorrhachis usually are managed conservatively. The entrapped gas occupying parts of the cerebrospinal compartment may cause syndromes of both intracranial and intraspinal hypertension, as well as hypotension as a consequence to either an increase or decrease of intracranial and intraspinal pressure ³.

Pneumorrhachis can in rare cases cause symptoms of cord compression and may even require decompressive surgery. Hence, rapid evaluation and diagnosis remain important ⁸.

History and etymology

The term pneumorrhachis derives from the Ancient Greek, πνεῦμα (pneuma) meaning air and ῥάχις (rachis) meaning spine.

Differential diagnosis

Consider intradiscal gas from degenerative disc disease ¹². A posteriorly bulging disc containing gas, in particular, may appear intrathecal in location. Sagittal views are helpful in establishing location of gas.

References

1. Place JN, Pezzuti RT. Clinical significance of traumatic pneumorrhachis. AJR Am J Roentgenol. 1989;153 (3): 655. AJR Am J Roentgenol (citation) - Pubmed citation
2. Cayli SR, Koçak A, Kutlu R et-al. Spinal pneumorrhachis. Br J Neurosurg. 2003;17 (1): 72-4. - Pubmed citation
3. Oertel MF, Korinth MC, Reinges MH et-al. Pathogenesis, diagnosis and management of pneumorrhachis. Eur Spine J. 2006;15 Suppl 5 : 636-43. doi:10.1007/s00586-006-0160-6 - Free text at pubmed - Pubmed citation
4. Schneider LJ, Haller JO, Cao H. CT recognition of spinal epidural air after chest tube placement. Pediatr Radiol. 1995;25 (3): 228. - Pubmed citation
5. Scialdone CJ, Wagle W. Intraspinal air: an unusual manifestation of blunt chest trauma. Clin Imaging. 1990;14 (1): 59-60. - Pubmed citation
6. Lin MB, Cheah FK, Ng SE et-al. Tension pneumocephalus and pneumorachis secondary to subarachnoid pleural fistula. Br J Radiol. 2000;73 (867): 325-7. Br J Radiol (abstract) - Pubmed citation
7. Hazouard E, Koninck JC, Attucci S et-al. Pneumorachis and pneumomediastinum caused by repeated Müller's maneuvers: complications of marijuana smoking. Ann Emerg Med. 2001;38 (6): 694-7. doi:10.1067/mem.2001.118016 - Pubmed citation
8. Chaichana KL, Pradilla G, Witham TF et-al. The clinical significance of pneumorachis: a case report and review of the literature. J Trauma. 2010;68 (3): 736-44. doi:10.1097/TA.0b013e3181c46dd3 - Pubmed citation
9. Newbold RG, Wiener MD, Vogler JB et-al. Traumatic pneumorrhachis. AJR Am J Roentgenol. 1987;148 (3): 615-6. doi:10.2214/ajr.148.3.615 - Pubmed citation
10. Sinha PA, Mantle M. Cervical pneumorrhachis. Clin Radiol. 2000;55 (7): 569-70. doi:10.1053/crad.1999.0099 - Pubmed citation
11. S. Challita, M. Daher, N. Roche, M. Alifano, M.P. Revel, A. Rabbat. Pneumorachis after cocaine sniffing. Respiratory Medicine Case Reports. 2014; Vol.12:10–12, doi:10.1016/j.rmcr.2013.12.011 http://www.sciencedirect.com/science/article/pii/S2213007114000161
12. Hidalgo-Ovejero AM, Martinez-Grande M, Garcia-Mata S. Disc herniation with gas. Spine. 1995;19 (19): 2210-2. Pubmed citation

Incoming Links

Promoted articles (advertising)

ADVERTISEMENT: Supporters see fewer/no ads

{"current_user":null,"inclusions":[{"imageId":31497,"studyId":8107,"caseSlug":"pneumorrhachis-1","caption":"Case 1: with added pneumomediastinum","thumbnail":"https://prod-images-static.radiopaedia.org/images/31497/2cdbd8e7f4eb47aab20c8ac60415f2_big_gallery.jpg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":17664731,"studyId":44115,"caseSlug":"boerhaave-syndrome-with-mediastinal-axillary-neck-and-epidural-free-gas","caption":"Case 2: with Boerhaave syndrome","thumbnail":"https://prod-images-static.radiopaedia.org/images/17664731/1bdd49c681248deb1414f0ca41e971_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":42403814,"studyId":71489,"caseSlug":"pneumomediastinum-and-pneumorrhachis","caption":"Case 3","thumbnail":"https://prod-images-static.radiopaedia.org/images/42403814/f48cf90a74c1292ca2ee354188b5fa_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":55296325,"studyId":108139,"caseSlug":"traumatic-pneumorrhachis","caption":"Case 4: traumatic pneumorrhachis","thumbnail":"https://prod-images-static.radiopaedia.org/images/55296325/IMG-0001-00101_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":55495859,"studyId":109133,"caseSlug":"unstable-thoracic-spine-fracture-dislocation","caption":"Case 5: traumatic pneumorrhachis","thumbnail":"https://prod-images-static.radiopaedia.org/images/55495859/f3310a2d1bd56a742483b951a70fddac551d31a33f62553cae79915eb5700d55_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":55739739,"studyId":110302,"caseSlug":"pneumorrhachis-4","caption":"Case 6: non-traumatic pneumorrhachis","thumbnail":"https://prod-images-static.radiopaedia.org/images/55739739/3a8cd0d05673cfdc5feed0aaba80022c9a65c3b1f823874cbb57a4704c9d29d2_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":54148952,"studyId":101262,"caseSlug":"pneumorrhachis-3","caption":"Case 7: due to intervertebral disc vacuum phenomenon","thumbnail":"https://prod-images-static.radiopaedia.org/images/54148952/IMG-0010-00255_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":63146733,"studyId":140037,"caseSlug":"pneumomediastinum-and-epidural-gas","caption":"Case 8","thumbnail":"https://prod-images-static.radiopaedia.org/images/63146733/017921764ab3f74ee02a97b908cbc23abd6ffe9bee801415f67a2f4c1b853d48_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"}],"ddx_inclusions":[],"lang":"us"}

Pneumorrhachis

Citation, DOI, disclosures and article data

On this page:

Clinical presentation

Pathology

Etiology