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Case Reports
. 2024 Apr 30;19(7):2898-2903.
doi: 10.1016/j.radcr.2024.03.085. eCollection 2024 Jul.

Epidural injection-related pneumorrhachis: A case report with cauda equina syndrome

Nguyen Xuan Khai  1 , Truong Dinh Tien  2 , Hoang Thi Dung  3 , Nguyen Duc Thuan  3 , Nguyen Huy Thong  4 , Nguyen Tien Dung  5 , Nguyen Viet Dung  6 , Nguyen Viet Phuong  7 , Ngo Tuan Minh  1
Affiliations
Case Reports

Epidural injection-related pneumorrhachis: A case report with cauda equina syndrome

Nguyen Xuan Khai et al. Radiol Case Rep. .

Abstract

Pneumorrhachis (PR) is an uncommon condition characterized by the accumulation of air within the spinal canal. This finding may occur due to various causes, mostly after trauma and medical procedures. It can manifest with various features depending on the underlying cause, the location, and the extent of the air trapped. Clinically, the symptoms in affected patients can span a spectrum, ranging from being asymptomatic to manifesting as radiculopathies resulting from compression. The pneumorrhachis-related cauda equina syndrome is incredibly rare and typically appears as a large volume of air causing compression or irritation of the nerve roots in the lower spinal cord. In this report, we present a female patient whose cauda equina syndrome developed as a result of accidental extradural pneumorrhachis after epidural injection in the lumbar spine.

Keywords: Cauda equina syndrome; Epidural injection; Magnetic resonance imaging; Pneumorrhachis; Spine.

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Figures

Fig 1
Fig. 1
(A) The CT image and T1W image reveal compression of the vertebral bodies at L1 and L3. (B) Axial and sagittal T2W images reveal an annular tear in the intervertebral L5/S1 disc.
Fig 2
Fig. 2
Axial (A) and sagittal (B) CT image show the presence of an air sac in the epidural space at the L4-L5 level.
Fig 3
Fig. 3
T1W sagittal image (A), T2W sagittal image (B) and T2W axial image (C) show partial resolution of gas collection in the epidural space at the L4-L5 level.
See this image and copyright information in PMC

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