Traumatic pneumorrhachis: systematic review and an illustrative case
Temidayo Osunronbi1, Agbolahan Sofela2,3, Himanshu Sharma4
1Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK.
Neurosurgical Review
|April 21, 2020
Summary
Pneumorrhachis (PR), or spinal canal air, is often linked to trauma. Most traumatic PR cases resolve spontaneously with conservative management, and prophylactic antibiotics show no benefit in preventing meningitis.
Area of Science:
- Trauma Surgery
- Neurosurgery
- Radiology
Background:
- Pneumorrhachis (PR) is defined as free air within the spinal canal.
- Traumatic PR necessitates a comprehensive understanding of its clinical spectrum, diagnostic modalities, and management strategies.
Observation:
- A systematic review analyzed 96 traumatic PR cases, with 80% resulting from blunt trauma.
- CT scans demonstrated 100% sensitivity for diagnosing PR, significantly outperforming MRI (60%) and plain radiographs (48%).
- Concurrent injuries were common, including pneumocephalus (42%), pneumothorax (36%), and spine fractures (27%).
Findings:
- Neurological symptoms directly attributed to PR, such as radiculopathy or myelopathy, occurred in 9% of patients.
- Conservative management was universally applied, leading to spontaneous resolution in 96% of cases within a median of 10 days.
- Prophylactic antibiotics did not reduce meningitis incidence (3% overall), suggesting they are not indicated for traumatic PR.
Implications:
- Traumatic PR is frequently associated with other air distributions and injuries, requiring thorough evaluation.
- The findings support conservative management for traumatic PR and question the routine use of prophylactic antibiotics for meningitis prevention.
- Further research may clarify the specific indications for intervention in rare symptomatic PR cases.
