Introduction

Methods & Materials

Results

Conclusions

Air in the spinal canal is called

pneumorrhachis. It is also described as

aerorachia, intraspinal pneumocele or

pneumomyelogram. It is a rare but

documented complication of many

traumatic (pneumothorax, blunt chest

trauma, spinal fracture, basilar skull

fracture, elective cranial surgery) and non

traumatic events (vertebral metastases,

spontaneous pneumomediastinum, open

myelomeningocele ).

X-rays of the thoracic spine revealed

comminuted fracture of first dorsal vertebra

(DV1), while X ray chest was negative for

pneumothorax or mediastinal widening (Fig

1). The patient underwent CT scan of the

cervicodorsal spine. It was suggestive of

fracture of spinous process and left lamina

of DV1 along with spinal stenosis and air in

the spinal canal. (Fig 2) There was no gross

spinal instability.

Clinically the patient had Spinal cord Injury

(SCI) T2 American Spinal Injury Association

(ASIA) Impairment Scale-A. Debridement of

the gunshot wounds was performed. He was

managed conservatively for the spinal

fracture and transferred to our rehabilitation

unit, two weeks after the injury. He

underwent a comprehensive SCI

rehabilitation program, which included

physical therapy, transfers training, wheel

chair mobility skills, occupational therapy,

bladder and bowel management as well as

counseling sessions.

The gunshot wounds healed well and his 6

months stay in the rehabilitation

department was uneventful. The air in the

spinal canal did not interfere with the

mobility or rehabilitation protocols of the

patient. A repeat CT scan after two

months showed complete resolution of the

pneumorrhachis. At one year follow up

there is no improvement in the

neurological status of the patient and he

is wheelchair dependent for mobility.

A 32 years old previously healthy male

soldier sustained a gunshot wound to lower

portion of the neck during a military

operation. The bullet entered anteriorely on

the left side of the neck. He had immediate

loss of movement in all four limbs along with

loss of sensation. He fell down, but did not

lose consciousness. He was evacuated to a

tertiary care hospital by road. Upon arrival

he had stable vital signs with a Glasgow

Coma Scale score of 15 and could recount

the events leading to his injury. There were

no complaints of dysphagia or respiratory

difficulty at presentation and during his stay

at the rehabilitation department.

Presence of air in spinal canal itself is

harmless and absorbs spontaneously in due

course of time, yet some patients may

require surgical repair of the torn dura mater

to prevent bacterial meningitis and stop CSF

leakage. However, it should be realized that

in a rare number of cases, pneumorrhachis

can cause symptoms of cord compression

and may even require decompressive

surgery. Therefore, prompt evaluation and

diagnosis remain important.

Figures 1 and 2: X ray of the thoracic spine shows communited fracture of the first thoracic vertebrae. There is no mediastinal widening or

pneumothorax

Pneumorrhachis of thoracic spine after gunshot wound

Farooq A. Rathore 1 , Zaheer A. Gill 2 , Amjad Yasin 3

1 Department of Rehabilitation Medicine, Combined Military Hospital, Panoaqil Cantt, 65130 Sindh, Pakistan

2 Spinal Unit, Armed Forces Institute of Rehabilitation Medicine , Abid Majeed Road, Rawalpindi, 46000, Pakistan

3Department of General Surgery, Combined Military Hospital, Rawalpindi 4600, Pakistan.

ISPRM Symposium on Rehabilitation Disaster Relief at the 6th ISPRM World Conference in Puerto Rico 2011

13 June 2011San Juan Puerto Rico

Introduction Results

Case Presentation

Figure 3: CT scan ( Axial slice) reveals fracture of spinous process and left lamina of DV1 along with spinal stenosis and presence of multiple

air shadows in the spinal canal( Pneumorrchahis)