Pothiawala S, Civil I. Narrative review of traumatic pneumorrhachis. World J Crit Care Med 2023; 12(5): 248-253 [PMID: 38188452 DOI: 10.5492/wjccm.v12.i5.248]
Corresponding Author of This Article
Sohil Pothiawala, MBBS, MD, Doctor, Trauma and Emergency Services, Auckland City Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand. drsohilpothiawala@yahoo.com
Research Domain of This Article
Emergency Medicine
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
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.
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.
