Spontaneous pneumorrhachis in adolescents: illustrative case

Spontaneous pneumorrhachis, defined as the presence of air in the spinal canal without trauma or iatrogenic intervention, is rare in adolescents. The clinical course remains anecdotal, and no standardized management guidelines exist. The authors performed the first systematic review focused on adolescent spontaneous pneumorrhachis and describe an illustrative case.

A 16-year-old previously healthy female presented with facial crepitus, intractable vomiting, fever, and streptococcal pharyngitis. Imaging revealed extensive pneumomediastinum, subcutaneous emphysema, and posterior epidural pneumorrhachis spanning from C7 to T8. Given a neurointact examination, conservative management was pursued. A systematic review of the literature assessed predisposing conditions, presenting symptoms, associated radiographic findings, and clinical management.

Pneumorrhachis should be considered in adolescents presenting with crepitus following vomiting or respiratory illness, particularly when accompanied by facial or cervical swelling. While the clinical course is typically benign, neurosurgical evaluation is valuable in distinguishing this condition from other causes of intraspinal air and to avoid neurological compromise. We propose a focused approach for the management of spontaneous pneumorrhachis in adolescence focused on treating the underlying condition, conservative management when no neurological deficits are present, and close neurological monitoring. https://thejns.org/doi/10.3171/CASE26332.