Pneumorrhachis Following Neck Penetrating Injury: A Case Report

Abstract

The development of air in the spinal canal is an uncommon and usually asymptomatic event. Also known as pneumorrhachis (PNR), the main information about this phenomenon is based on a few case reports published previously. It is highly difficult to identify this entity clinically, and in most publications, PNR was incidentally identified during image procedures, mainly computed tomography (CT) scans. With the advancement of technology and the development of guidelines for the treatment of penetrating and neck injuries, the number of PNR diagnosis has increased. It is also a common agreement among the articles reviewed that the least common cause of PNR is traumatic events. This report presents a rare case of pneumorrhachis as a consequence of a penetrating neck injury. The studied patient was a 27-year-old female with multiple stab wounds on the left posterior side of the neck and left shoulder, thereby developing left-side body weakness as a consequence of the wound. The patient was immediately evaluated and managed by the emergency team, and as the patient was vitally stable, she was shifted to an urgent CT scan. CT scan showed subarachnoid air focus, multiple extradural air foci, and spinal cord injury on the cervical spine. This patient was treated conservatively, but her neurological symptoms persisted until discharge.

Keywords: free air on spinal canal; head and neck trauma; neck; penetrating neck injury; pneumocele; pneumorrhachis.

Figure 1. CT image showing intrathecal air focus at the C2-C3 level on the right side

Figure 2. CT image showing multiple extradural air foci on the left cervical spinal from C4 to C6 level

Figure 3. MRI image showing spinal cord injury at C3-C4 and C5-C6 levels