Traumatic air in spinal canal (pneumorrhachis)

Background
Pneumorrhachis (PR) means the presence of air in the spinal canal; it is an exceptional, but important radiographic finding, which may be associated with different aetiologies and pathways of air entry into the spinal canal.

Case report
An 18-year-old male was admitted to hospital after a road traffic accident. He was conscious, with several abrasions and subcutaneous haematoma and emphysema on the left side, but no pneumothorax. Ultrasound of the abdomen showed a grade 2 splenic rupture with minimal bleeding. CT revealed no fractures but the presence of air in the spinal canal. The patient was placed on conservative treatment and discharged home without any complications or sequelae.

Discussion and conclusion
PR can be epidural or subdural, iatrogenic or traumatic. It is usually asymptomatic, but can be also associated with marked morbidity, especially when it is subdural in the cervical region. It can be regarded as a predictor of the severity of head injury. Pneumorrhachis does not usually require surgical intervention.