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European Spine Journal
Published in: European Spine Journal 5/2006

01-10-2006 | Case Report

Pathogenesis, diagnosis and management of pneumorrhachis

Authors: Markus F. Oertel, Marcus C. Korinth, Marcus H. T. Reinges, Timo Krings, Sandra Terbeck, Joachim M. Gilsbach

Published in: European Spine Journal | Special Issue 5/2006

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Abstract

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.
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Metadata
Title
Pathogenesis, diagnosis and management of pneumorrhachis
Authors
Markus F. Oertel
Marcus C. Korinth
Marcus H. T. Reinges
Timo Krings
Sandra Terbeck
Joachim M. Gilsbach
Publication date
01-10-2006
Publisher
Springer-Verlag
Published in
European Spine Journal / Issue Special Issue 5/2006
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-006-0160-6

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