Cervicothoracolumbar pneumorachis. Case report and review of the literature.

Background: Pneumorachis is a very rare entity to occur after a major trauma. It is even rarer when its occurrence is not associated with injuries in the skull base, chest, abdomen, pelvis, or spine. Pneumorachis extending through the entire spinal canal has never been reported.

Case Description: We report a case of traumatic air penetration into the spinal canal in a patient, involved in a road traffic accident, who had no apparent major bone and soft tissue injuries. The patient was conscious (Glasgow Coma Scale score of 15/15) upon admission. A cervical lateral x-ray taken the day after admission showed some air in the spinal canal. A subsequent computed tomography with reconstruction disclosed some subdural air extending from the cervical region to the lumbar region. The patient was successfully treated conservatively. The pathogenesis and rarity of this pathology are discussed along with the review of relevant literature.

Conclusion: Any patient with spinal pneumorachis should be actively investigated to determine if a possible air fistula, which might increase causing spinal cord compression, is present. If a source is not found, a skull base fracture should be suspected.