Pneumorrhachis After Inadvertent Dural Puncture as a Cause of Severe Neck Pain Limiting Labor Participation and
Nancy H Greenspon1, Jason R Farrer2
1From the Department of Anesthesiology, McGaw Medical Center of Northwestern University, Chicago, Illinois.
Pneumorrhachis, defined as the presence of air within the spinal canal, is generally regarded as a benign radiological finding. In obstetrics, it is most frequently associated with use of the loss of resistance (LOR) to air technique during neuraxial procedures. We present a unique case of symptomatic pneumorrhachis after inadvertent dural puncture using the LOR to saline technique. The patient developed severe, refractory neck pain that precluded effective maternal Valsalva efforts during the second stage of labor, ultimately necessitating an operative vaginal delivery. This case illustrates that pneumorrhachis, while typically asymptomatic, can produce significant morbidity capable of altering obstetrical management.
Pneumorrhachis, defined as the presence of air within the spinal canal, is generally regarded as a benign radiological finding. In obstetrics, it is most frequently associated with use of the loss of resistance (LOR) to air technique during neuraxial procedures. We present a unique case of symptomatic pneumorrhachis after inadvertent dural puncture using the LOR to saline technique. The patient developed severe, refractory neck pain that precluded effective maternal Valsalva efforts during the second stage of labor, ultimately necessitating an operative vaginal delivery. This case illustrates that pneumorrhachis, while typically asymptomatic, can produce significant morbidity capable of altering obstetrical management.
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