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World J Crit Care Med. Dec 9, 2023; 12(5): 248-253
Published online Dec 9, 2023. doi: 10.5492/wjccm.v12.i5.248
Narrative review of traumatic pneumorrhachis
Sohil Pothiawala, Ian Civil
Sohil Pothiawala, Trauma and Emergency Services, Auckland City Hospital, Auckland 1023, New Zealand
Sohil Pothiawala, Emergency Medicine, Woodlands Health, Singapore 768024, Singapore
Ian Civil, Trauma Services, Auckland City Hospital, Auckland 1023, New Zealand
Author contributions: Pothiawala S conceptualized and drafted the initial and revised versions of the manuscript; Civil I reviewed and edited the manuscript; All authors accept the final version of the manuscript.
Conflict-of-interest statement: All authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sohil Pothiawala, MBBS, MD, Doctor, Trauma and Emergency Services, Auckland City Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand. drsohilpothiawala@yahoo.com
Received: July 9, 2023
Peer-review started: July 9, 2023
First decision: August 24, 2023
Revised: August 31, 2023
Accepted: October 30, 2023
Article in press: October 30, 2023
Published online: December 9, 2023
Processing time: 151 Days and 0.9 Hours
Abstract

Pneumorrhachis (PR) is defined as presence of free air in the spinal canal. Traumatic PR is very rare, and its exact incidence and pathogenesis is unknown. A comprehensive literature search was performed using the PubMed, Cochrane Library, Google Scholar and Scopus databases to identify articles relevant to traumatic PR published till January 2023. A total of 34 resources were selected for inclusion in this narrative review. Traumatic PR can be classified anatomically into epidural and intradural types. In the epidural type, air is present peripherally in the spinal canal and the patients are usually asymptomatic. In contrast, in intradural PR, air is seen centrally in the spinal canal and patients present with neurological symptoms, and it is a marker of severe trauma. It is frequently associated with traumatic pneumocephalus, skull fractures or thoracic spine fracture. Computed tomography (CT) is considered to be the diagnostic modality of choice. Epidural PR is self-limited and patients are generally managed conservatively. Patients with neurological symptoms or persistent air in spinal canal require further evaluation for a potential source of air leak, with a need for surgical intervention. Differentiation between epidural and intradural PR is important, because the latter is an indication of severe underlying injury. CT imaging of the entire spine must be performed to look for extension of air, as well as to identify concomitant skull, torso or spinal injuries Most patients are asymptomatic and are managed conservatively, but a few may develop neurological symptoms that need further evaluation and management.

Keywords: Pneumorrhachis; Trauma; Intraspinal air; Spinal emphysema

Core Tip: Traumatic Pneumorrhachis (PR) is defined as presence of free air in the spinal canal, and is very rare. Differentiation between epidural and intradural PR is important, because the latter is an indication of severe underlying injury. Computed tomography imaging of the entire spine must be performed to look for extension of air, as well as identify concomitant skull, torso or spinal injuries. Most patients are asymptomatic and are managed conservatively, but a few may develop neurological symptoms that need further evaluation and management.