Traumatic pneumorrhachis: systematic review and an illustrative case.
Intraspinal air
Pneumorrhachis
Spinal canal
trauma
Journal
Neurosurgical review
ISSN: 1437-2320
Titre abrégé: Neurosurg Rev
Pays: Germany
ID NLM: 7908181
Informations de publication
Date de publication:
Apr 2021
Apr 2021
Historique:
received:
22
01
2020
accepted:
02
04
2020
revised:
08
03
2020
pubmed:
21
4
2020
medline:
16
6
2021
entrez:
21
4
2020
Statut:
ppublish
Résumé
Pneumorrhachis (PR) refers to free air in the spinal canal. We aim to describe a case report and conduct a systematic review focused on the clinical presentation, diagnosis, and management of traumatic PR. We conducted a language-restricted PubMed, SciELO, Scopus, and Ovid database search for traumatic PR cases published till June 2019. Categorical variables were assessed by Fisher's exact test. In addition to our reported index case, there were 82 articles (96 individual cases) eligible for meta-analysis according to our inclusion/exclusion criteria. Eighty per cent of patients had blunt trauma, while 17% had penetrating injuries. Thirty-four per cent of cases were extradural PR, 21% intradural PR, and unreported PR type in 43%. Nine per cent of patients presented with symptoms directly attributed to PR: sensory radiculopathy (2%), motor radiculopathy (1%), and myelopathy (6%). CT had a 100% sensitivity for diagnosing PR, MRI 60%, and plain radiograph 48%. Concurrent injuries reported include pneumocephalus (42%), pneumothorax (36%), spine fracture (27%), skull fracture (27%), pneumomediastinum (24%), and cerebrospinal fluid leak (14%). PR was managed conservatively in every case, with spontaneous resolution in 96% on follow-up (median = 10 days). Prophylactic antibiotics for meningitis were given in 13% PR cases, but there was no association with the incidence of meningitis (overall incidence: 3%; prophylaxis group (0%) vs non-prophylaxis group (4%) (p = 1)). Occasionally, traumatic PR may present with radiculopathy or myelopathy. Traumatic PR is almost always associated with further air distributions and/or underlying injuries. There is insufficient evidence to support the use of prophylactic antibiotic in preventing meningitis in traumatic PR patients.
Identifiants
pubmed: 32307638
doi: 10.1007/s10143-020-01300-8
pii: 10.1007/s10143-020-01300-8
doi:
Types de publication
Case Reports
Journal Article
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
731-739Références
Gordon IJ, Hardman DR (1977) The traumatic pneumomyelogram. A previously undescribed entity. Neuroradiology 13:107–108. https://doi.org/10.1007/bf00339843
doi: 10.1007/bf00339843
pubmed: 865671
Newbold RG, Wiener MD, Vogler JB, Martinez S (1987) Traumatic pneumorrhachis. Am J Roentgenol 148:615–616. https://doi.org/10.2214/ajr.148.3.615
doi: 10.2214/ajr.148.3.615
Chiba Y, Kakuta H (1995) Massive subcutaneous emphysema, pneumomediastinum, and spinal epidural emphysema as complications of violent coughing: a case report. Auris Nasus Larynx 22:205–208. https://doi.org/10.1016/S0385-8146(12)80061-7
doi: 10.1016/S0385-8146(12)80061-7
pubmed: 8561704
Goh BKP, Ng K-K, Hoe MNY (2004) Traumatic epidural emphysema. Spine (Phila Pa 1976) 29:E528–E530. https://doi.org/10.1097/01.brs.0000144832.03555.f5
doi: 10.1097/01.brs.0000144832.03555.f5
Mangiardi JR, Brisson P, Weitzner I, Bednar M (1987) Traumatic intraspinal pneumocele. Surg Neurol 27:587–588. https://doi.org/10.1016/0090-3019(87)90161-3
doi: 10.1016/0090-3019(87)90161-3
pubmed: 3576436
Yousaf I, Flynn P, McConnell R (2003) Symptomatic intraspinal pneumocoele resulting from closed head injury. Br J Neurosurg 17:248–249. https://doi.org/10.1080/0268869031000153143
doi: 10.1080/0268869031000153143
pubmed: 14565522
Prins TR, Vencken LM (1989) Traumatic pneumosaccus. Neuroradiology 31:290. https://doi.org/10.1007/BF00344366
doi: 10.1007/BF00344366
pubmed: 2779786
Harris PF, Abu-Hijleh MF, Grant CS, Daar AS (1997) Brachial plexus palsy and spinal subarachnoid pneumatosis following trauma. Clin Anat 10:419–423. https://doi.org/10.1002/(SICI)1098-2353(1997)10:6<419::AID-CA9>3.0.CO;2-J
doi: 10.1002/(SICI)1098-2353(1997)10:6<419::AID-CA9>3.0.CO;2-J
pubmed: 9358974
Kapur A, Sandhu S (1994) Epidural pneumatosis: not necessarily benign. Am J Neuroradiol 15:195–196
pubmed: 8141057
De Meulder A, Michaux L (1990) Aerorachia. Intensive Care Med 16:275–276. https://doi.org/10.1007/BF01705167
doi: 10.1007/BF01705167
pubmed: 2358564
Gertzbein SD (1998) Traumatic pneumomyelography: a marker of spinal column injury in the face of innocuous spine fractures: two case reports. Spine (Phila Pa 1976) 23:1283–1286. https://doi.org/10.1097/00007632-199806010-00022
doi: 10.1097/00007632-199806010-00022
Yip L, Sweeny PJ, Mccarroll KA (1990) The traumatic air myelogram. Am J Emerg Med 8:332–334. https://doi.org/10.1016/0735-6757(90)90089-I
doi: 10.1016/0735-6757(90)90089-I
pubmed: 2363757
Gelalis ID, Karageorgos A, Arnaoutoglou C, Gartzonikas D, Politis A, Georgakopoulos N, Petsanas AP, Matzaroglou C, Xenakis T (2011) Traumatic pneumorrhachis: etiology, pathomechanism, diagnosis, and treatment. Spine J 11:153–157. https://doi.org/10.1016/j.spinee.2010.12.010
doi: 10.1016/j.spinee.2010.12.010
pubmed: 21296300
Oertel MF, Korinth MC, Reinges MHT, Krings T, Terbeck S, Gilsbach JM (2006) Pathogenesis, diagnosis and management of pneumorrhachis. Eur Spine J 15:636–643. https://doi.org/10.1007/s00586-006-0160-6
doi: 10.1007/s00586-006-0160-6
pubmed: 16835735
pmcid: 1602196
Lin LC, Liao YM, Yang RC (2006) Pneumorrhachis following lumbar puncture: a case report. Kaohsiung J Med Sci 22:39–43. https://doi.org/10.1016/s1607-551x(09)70219-0
doi: 10.1016/s1607-551x(09)70219-0
pubmed: 16570568
Shin H, Choi HJ, Kim C, Lee I, Oh J, Ko BS (2018) Cardiac arrest associated with pneumorrhachis and pneumocephalus after epidural analgesia: two case reports. J Med Case Rep 12:387. https://doi.org/10.1186/s13256-018-1908-4
doi: 10.1186/s13256-018-1908-4
pubmed: 30577855
pmcid: 6303906
Bhat SB, Blumer S, Shah SA (2017) Epidural pneumorrhachis causing intraoperative loss of motor potentials during instrumented fusion for scoliosis: a case report. JBJS Case Connect 7:e53. https://doi.org/10.2106/JBJS.CC.16.00191
doi: 10.2106/JBJS.CC.16.00191
pubmed: 29252883
Lee G-S, Lee M-K, Kim W-J, Kim HS, Kim JH, Kim YS (2016) Pneumocephalus and pneumorrhachis due to a subarachnoid pleural fistula that developed after thoracic spine surgery. Korean J Spine 13:164–166. https://doi.org/10.14245/kjs.2016.13.3.164
doi: 10.14245/kjs.2016.13.3.164
pubmed: 27799999
pmcid: 5086471
Payne R, Sieg EP, Choudhary A, Iantosca M (2016) Pneumorrhachis resulting in transient paresis after PICC line insertion into the ascending lumbar vein. Cureus 8:e833. https://doi.org/10.7759/cureus.833
doi: 10.7759/cureus.833
pubmed: 27904815
pmcid: 5117705
Anaye A, Moschopoulos C, Agneessens E, Hainaux B (2008) Pneumoscrotum, pneumomediastinum, pneumothorax, and pneumorrhachis following colon surgery. Radiol Case Rep 3:216. https://doi.org/10.2484/rcr.v3i4.216
doi: 10.2484/rcr.v3i4.216
pubmed: 27303555
Iacoangeli M, Di Rienzo A, Fianchini A et al (2013) Acute tension pneumocephalus secondary to whole spine pneumorrhachis as an unusual presentation of a colon cancer complicated by a transsacral cerebrospinal fluid leak. J Clin Neurosci 20:469–471. https://doi.org/10.1016/j.jocn.2012.02.032
doi: 10.1016/j.jocn.2012.02.032
pubmed: 23164825
Mahajan PS, Al Maslamani NJ, Purayil NK (2014) Rare case of pneumorrhachis, pneumomediastinum, pneumothorax, and surgical emphysema secondary to bronchial asthma. Int Med Case Rep J 7:35–39. https://doi.org/10.2147/IMCRJ.S60050
doi: 10.2147/IMCRJ.S60050
pubmed: 24623994
pmcid: 3949721
Sankar J, Jain A, Suresh CP (2013) Peanut aspiration leading to pneumorrhachis in a pre-schooler. BMJ Case Rep 2013:bcr2012007675. https://doi.org/10.1136/bcr-2012-007675
doi: 10.1136/bcr-2012-007675
pubmed: 23362075
pmcid: 3604244
Sethi BA, Cooper JG (2018) Pneumorrhachis after recreational drug use. J Radiol Case Rep 12:1–5. https://doi.org/10.3941/jrcr.v12i4.3103
doi: 10.3941/jrcr.v12i4.3103
pubmed: 29875991
pmcid: 5965289
Rehman TA, Mammen T, Thaj J, Cherian RS (2009) Is pneumorrhachis a poor prognostic sign in acute gangrenous abdominal emergencies? Emerg Radiol 16:151–154. https://doi.org/10.1007/s10140-008-0708-3
doi: 10.1007/s10140-008-0708-3
pubmed: 18351407
Hall WB, Aris RM (2012) Epidural pneumatosis and diffuse soft tissue free air as a complication of diabetic ketoacidosis. Am J Respir Crit Care Med 185:e5. https://doi.org/10.1164/rccm.201105-0916IM
doi: 10.1164/rccm.201105-0916IM
pubmed: 22336688
pmcid: 3297094
de Roos PB, van Lindert EJ, van der Vliet TA, Sie LTL (2009) MRI of pneumorachis in a newborn infant with open myelomeningocele. Pediatr Neurol 40:377–379. https://doi.org/10.1016/j.pediatrneurol.2008.11.019
doi: 10.1016/j.pediatrneurol.2008.11.019
pubmed: 19380075
Krishnan P, Das S, Bhattacharyya C (2017) Epidural pneumorrhachis consequent to Hamman syndrome. J Neurosci Rural Pract 8:118–119. https://doi.org/10.4103/0976-3147.193525
doi: 10.4103/0976-3147.193525
pubmed: 28149094
pmcid: 5225692
Bozkurt G, Turk CC, Ayhan S et al (2011) Cervical pneumorrhachis caused by impact loading forces after skull base fracture: case report and review of the literature. Cent Eur Neurosurg 72:215–218. https://doi.org/10.1055/s-0030-1252008
doi: 10.1055/s-0030-1252008
pubmed: 20535666
Goh BKP, Yeo AWY (2005) Traumatic pneumorrhachis. J Trauma 58:875–879. https://doi.org/10.1097/01.ta.0000158249.77176.9a
doi: 10.1097/01.ta.0000158249.77176.9a
pubmed: 15824674
Chun BJ, Moon JM (2009) Symptomatic epidural pneumorrhachis associated with an occult pneumomediastinum due to minor trauma. Spine (Phila Pa 1976) 34:E979–E982. https://doi.org/10.1097/BRS.0b013e3181b03ecb
doi: 10.1097/BRS.0b013e3181b03ecb
Ould-Slimane M, Ettori MA, Lazennec JY et al (2010) Pneumorachis: a possible source of traumatic cord compression. Orthop Traumatol Surg Res 96:825–828. https://doi.org/10.1016/j.otsr.2010.03.024
doi: 10.1016/j.otsr.2010.03.024
pubmed: 20888314
Neve M, Naudin J, Sachs P, Dauger S (2011) Pneumorrhachis in a 2-month-old after an accidental gunshot injury. J Pediatr 159:163. https://doi.org/10.1016/j.jpeds.2011.02.041
doi: 10.1016/j.jpeds.2011.02.041
pubmed: 21489558
Kim SW, Seo HJ (2013) Symptomatic epidural pneumorrhachis: a rare entity. J Korean Neurosurg Soc 54:65–67. https://doi.org/10.3340/jkns.2013.54.1.65
doi: 10.3340/jkns.2013.54.1.65
pubmed: 24044086
pmcid: 3772292
Koktekir E, Tatarli N, Ceylan D et al (2014) Symptomatic pneumorrhachis. J Neurol Surg A Cent Eur Neurosurg 75:140–145. https://doi.org/10.1055/s-0032-1333123
doi: 10.1055/s-0032-1333123
pubmed: 23427038
Kara H, Akinci M, Degirmenci S et al (2015) Traumatic pneumorrhachis: 2 cases and review of the literature. Am J Emerg Med 33:861.e1–861.e3. https://doi.org/10.1016/j.ajem.2014.12.040
doi: 10.1016/j.ajem.2014.12.040
Kalogerakos PD, Lazopoulos G, Palioudakis S, Drositis I, Chionidou K, Chalkiadakis G (2017) Pneumorachis associated with persistent tachycardia after blunt thoracic trauma. Asian Cardiovasc Thorac Ann 25:463–465. https://doi.org/10.1177/0218492317717421
doi: 10.1177/0218492317717421
pubmed: 28610438
Burn JMB, Guyer PB, Langdon L (1973) The spread of solutions injected into the epidural space: a study using epidurograms in patients with the lumbosciatic syndrome. Br J Anaesth 45:338–345. https://doi.org/10.1093/bja/45.4.338
doi: 10.1093/bja/45.4.338
pubmed: 4267504
Silver SF, Nadel HR, Flodmark O (1988) Pneumorrhachis after jejunal entrapment caused by a fracture dislocation of the lumbar spine. Am J Roentgenol 150:1129–1130. https://doi.org/10.2214/ajr.150.5.1129
doi: 10.2214/ajr.150.5.1129
Dehner JR (1971) Seatbelt injuries of the spine and abdomen. Am J Roentgenol Radium Therapy, Nucl Med 111:833–843. https://doi.org/10.2214/ajr.111.4.833
doi: 10.2214/ajr.111.4.833
Agha FP, Raji MR (1982) Oesophageal perforation with fracture dislocation of cervical spine due to hyperextension injury. Br J Radiol 55:369–372. https://doi.org/10.1259/0007-1285-55-653-369
doi: 10.1259/0007-1285-55-653-369
pubmed: 7082916
Chimon JL, Cantos EL (1990) CT recognition of spinal epidural air after pelvic trauma. J Comput Assist Tomogr 14:795–796. https://doi.org/10.1097/00004728-199009000-00023
doi: 10.1097/00004728-199009000-00023
pubmed: 2398163
Dandy WE (1919) Röntgenography of the brain after the injection of air into the spinal canal. Ann Surg 70:397–403. https://doi.org/10.1097/00000658-191910000-00004
doi: 10.1097/00000658-191910000-00004
pubmed: 17864170
pmcid: 1410386
Scialdone CJ, Wagle W (1990) Intraspinal air: an unusual manifestation of blunt chest trauma. Clin Imaging 14:59–60. https://doi.org/10.1016/0899-7071(90)90121-Q
doi: 10.1016/0899-7071(90)90121-Q
pubmed: 2322885
Delamarter RB, Heller J, Bohlman HH (1989) Cervical pneumomyëlogram secondary to a closed fracture-dislocation of the thoracic spine: a case report. Spine (Phila Pa 1976) 14:1421–1422. https://doi.org/10.1097/00007632-198912000-00025
doi: 10.1097/00007632-198912000-00025
Alkan A, Baysal T, Saras K, Sigirci A, Kutlu R (2002) Early MRI findings in stab wound of the cervical spine: two case reports. Neuroradiology 44:64–66. https://doi.org/10.1007/s002340100646
doi: 10.1007/s002340100646
pubmed: 11942503
Bernaerts A, Verniest T, Vanhoenacker F, van den Brande P, Petré C, de Schepper AM (2003) Pneumomediastinum and epidural pneumatosis after inhalation of “ecstacy”. Eur Radiol 13:642–643. https://doi.org/10.1007/s00330-002-1466-3
doi: 10.1007/s00330-002-1466-3
pubmed: 12659082
Arora S, Aggarwal P, Cheema G, Singla J (2011) Pneumorachis of the cervical spine with associated pneumocephalus and subcutaneous emphysema. Indian J Orthop 45:372–375. https://doi.org/10.4103/0019-5413.82346
doi: 10.4103/0019-5413.82346
pubmed: 21772634
pmcid: 3134026
Chaichana KL, Pradilla G, Witham TF, Gokaslan ZL, Bydon A (2010) The clinical significance of pneumorachis: a case report and review of the literature. J Trauma 68:736–744. https://doi.org/10.1097/TA.0b013e3181c46dd3
doi: 10.1097/TA.0b013e3181c46dd3
pubmed: 20220428
Rovlias A, Pavlakis E, Kotsou S (2006) Symptomatic pneumorachis associated with incidental durotomy during microscopic lumbar disc surgery: case report. J Neurosurg Spine 5:165–167. https://doi.org/10.3171/spi.2006.5.2.165
doi: 10.3171/spi.2006.5.2.165
pubmed: 16925085
Kennedy TM, Ullman DA, Harte FA, Saberski LR, Greenhouse BB (1988) Lumbar root compression secondary to epidural air. Anesth Analg 67:1184–1186. https://doi.org/10.1213/00000539-198812000-00015
doi: 10.1213/00000539-198812000-00015
pubmed: 3195736
Song KJ, Lee KB (2009) Spontaneous extradural pneumorrhachis causing cervical myelopathy. Spine J 9:e16–e18. https://doi.org/10.1016/j.spinee.2008.01.011
doi: 10.1016/j.spinee.2008.01.011
pubmed: 18375187
Minville V, Amathieu R, Adnet F, Asehnoune K (2006) CT recognition of traumatic pneumomyelogram. Eur J Anaesthesiol 23:975–977. https://doi.org/10.1017/S0265021506211396
doi: 10.1017/S0265021506211396
pubmed: 17018174
Derner M, Drugová B, Hořejší L, Skvára D, Druga R (2011) Massive pneumorrhachis, pneumocephalus and pneumoopticus following thoracic trauma and avulsion of the brachial plexus: case report and review of the literature. Prague Med Rep 112:56–66
pubmed: 21470500
Gullupinar B, Topacoglu H (2014) Subarachnoid pleural fistula due to gunshot wound. Turk J Emerg Med 14:87–89. https://doi.org/10.5505/1304.7361.2014.93271
doi: 10.5505/1304.7361.2014.93271
pubmed: 27331176
Katz DS, Groskin SA, Wasenko JJ (1994) Pneumorachis and pneumocephalus caused by pneumothorax and multiple thoracic vertebral fractures. Clin Imaging 18:85–87. https://doi.org/10.1016/0899-7071(94)90154-6
doi: 10.1016/0899-7071(94)90154-6
pubmed: 8180870