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Pneumorrhachis refers to the presence of gas within the spinal canal (either intra- or extradural). It is rare.
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Patients can often be asymptomatic 3.
Pneumorrhachis can result from a number of causes:
- trauma (traumatic pneumorrhachis): can occur in a variety of traumatic settings
- traumatic pneumothorax
- blunt chest trauma 5
- skull fracture
- iatrogenic / post surgical
- epidural anesthesia
- thoracic / lumbar surgery
- spontaneous pneumomediastinum (e.g. from bronchial asthma, Hamman syndrome)
- regional necrotizing fasciitis (rare)
- marijuana smoking
- cocaine snorting 11
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.
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.
- 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
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- 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