Traumatic pneumorrhachis

Area of Science:

• Radiology
• Trauma Surgery
• Spinal Imaging

Background:

• Traumatic pneumorrhachis (PR) is a rare condition, with few reported cases, often incidentally found on CT scans.
• The pathogenesis of traumatic PR is not fully understood but is hypothesized to involve air migration along fascial planes following increased thoracic pressure.
• This study presents the largest case series of traumatic PR to date, offering insights into diagnosis and management.

Purpose of the Study:

• To review and analyze cases of traumatic pneumorrhachis (PR) over a 13-year period.
• To contribute to the understanding of the diagnostic and therapeutic approaches for traumatic PR.
• To provide the largest case series of traumatic PR in the literature.

Main Methods:

• Retrospective review of radiological findings in patients with thoracic trauma from 2004 to 2016.
• Identification and recording of eight patients with traumatic epidural PR, including associated injuries, treatments, and outcomes.
• Systematic literature review to supplement case findings.

Main Results:

• Eight patients with traumatic PR were identified, with one case showing combined epidural and subarachnoid PR after open skull injury.
• One patient developed spondylodiscitis nine months post-trauma at the level of the PR.
• Spontaneous resolution of air in the spinal canal was observed on CT scan within four days in one patient.

Conclusions:

• Traumatic PR is a rare entity diagnosable with CT and MRI, typically requiring no specific initial treatment beyond managing associated injuries.
• The prognosis for traumatic epidural PR is generally good and is primarily dependent on the severity of accompanying injuries.
• Clinicians should consider the potential development of spondylodiscitis in patients with PR, especially if infection parameters are elevated.