Pneumorrhachis (PR) is defined as air within the spinal canal (either intra- or extra-dural). It is usually an imaging diagnosis, caused by numerous – mainly traumatic and iatrogenic – etiologies, and is usually associated with other pathologies and numerous air entry pathways. CT is the diagnostic modality of choice. PR is usually asymptomatic, is reabsorbed spontaneously and is usually managed conservatively. Prophylactic management with antibiotics is not recommended. In case general anesthesia is required, the use inhalational nitrous oxide is avoided because it causes expansion of intra-cavitary air.