Pneumocephalus and pneumorrhachis after spinal surgery: case report and review of the literature

Abstract

Trauma is a common cause of pneumocephalus, or air in the cranial cavity, and of pneumorrhachis, or the presence of intraspinal air. After spinal surgery, occurrence of pneumocephalus, especially with pneumorrhachis, is extremely rare. We report the case of a patient who developed pneumocephalus and pneumorrhachis after lumbar disc surgery and pedicle screw fixation. There was no cerebrospinal fluid leakage during surgery. On postoperative day 1, the patient complained of headache, nausea, and dizziness. Brain and lumbar computed tomography scans revealed pneumocephalus and pneumorrhachis. With conservative treatment, the patient's complaints resolved within 10 days.

Fig. 1

Lumbar magnetic resonance imaging shows a giant, inferiorly migrated, sequestered disc fragment at the right L3–4 level.

Fig. 2

Air densities are seen anterior to the brain stem and Meckel cave cisterns simulating an air cisternogram with discernible trigeminal nerves in the lung window settings. Air can be seen also in brain window settings.

Fig. 3

Sagittal reformation of the postoperative lumbar computed tomography in soft tissue window (left) and transverse cut from the L4 level at lung window (right) showing air densities in L3–4 intervertebral space, anterior-right to the dural sac, and in the posterior extradural regions.