Traumatic pneumorrhachis

Abstract

Introduction: Traumatic pneumorrhachis (PR) is a rare entity. There are only a few single cases published in English literature. In most of these cases PR was accidentally found during CT-diagnostics and remained asymptomatic. The exact pathogenesis of traumatic PR has not been conclusively clarified. It is assumed, that a sudden increase in thoracic pressure causes air to escape the alveoli and migrates along the fasciae towards the spinal canal. In this study we reviewed the patients of our clinic for 13 years. Eight Patients with traumatic PR could be detected. This study represents the biggest account of traumatic PR in literature and gives a hint for the diagnostic and therapeutical regimen.

Methods: We reviewed the radiological findings of our patients with thoracic trauma in the period from 2004 to 2016. We could detect eight patients with traumatic epidural PR and recorded any further injuries, therapies and outcome. Furthermore, a systematic literature review was carried out.

Results: We found a total of eight patients suffering from traumatic PR. One of them hat a combination of epidural and subarachnoidal PR due to an open skull injury. Another of these patients got spondylodiscites nine months later at the level of the PR. In one Patient we could show the spontaneous reabsorption of the air in a CT-scan 4 days after trauma.

Discussion: Traumatic PR remains a rare entity. It can be diagnosed with CT an MRT-scans. It needs no specific initial therapy besides the therapy of the underlying injuries. The prognosis of traumatic epidural PR is good and determined by the accompanying injuries. In cases of elevated paraclinical infection parameters one has to consider the development of spondylodiscitis in areas of PR.

Keywords: Aeroarrachy; Intraspinal air; Pneumomyelogram; Pneumomyelon; Spinal emphysema; Spinal pneumatosis; Traumatic pneumorrhachis.