Pneumorrhachis After an Upper Respiratory Infection: A Case Report of a Rare Phenomenon

Abstract

Pneumorrhachis (PR) is the presence of free air within the spinal canal. It is generally benign and improves with conservative management. Case reports and a literature review exist documenting the existence and potential pathogenesis of this phenomenon, but no evidencebased guidelines exist documenting what treatment, if any, is indicated for this condition. We present a case of a 21-year-old male who developed PR after a preceding upper respiratory tract infection. His symptoms improved with expectant management and administration of highflow oxygen. The purpose of this case report is to add to the scarce existing literature reporting this condition and to provide a short review of literature detailing the pathogenesis of PR.

Spontaneous Pneumorachis – A Case-Based Review

“…The trigger was unknown in 7 patients, upper respiratory tract infection/bronchitis/common cold in 6 cases, asthma exacerbation in 5 cases, emphysematous pyelonephritis in 3 patients, cocaine use in 3 patients, vomiting caused by diabetic ketoacidosis in 3 patients, an acute bout of dry cough in 2 cases and vacuum intervertebral disc in 2 cases. 7–9 Other causes include Valsalva maneuver, choking, ketamine sniffing, strenuous exercise, weightlifting, entero dural fistula, mucous plugging, pneumocystis pneumonia, spontaneous rupture of the bulla, bronchopleural dura subarachnoid fistula, bouts of self-induced vomiting in anorexia nervosa, vomiting induced by meningitis, transsacral cerebrospinal fluid leak, enterocutaneous fistula from the left natal cleft, and anterolisthesis of L5 over S1 in 1 patient each. 10–12…”

Clearing the air around spontaneous pneumorrhachis

“…[1] There is a theoretical benefit of introducing high-flow oxygen as it can increase the oxygen content of the entrapped gas, leading to more rapid absorption. [10,11] Surgical intervention is needed in cases associated with persistent spinal fluid leak or entrapment of air in the spinal canal due to the formation Table 3: Review of the literature (year-wise). of a one-way valve.…”

Spontaneous Pneumorrhachis Secondary to Rhinovirus-Associated Emesis with Demonstrated Pathophysiology

“…neumorrhachis, or air within spine canal, is a rare phenomenon in which gas has been introduced into the spinal column most commonly because of iatrogenic causes or traumatic insult 1 . However, there is an increasing number of case reports of spontaneous pneumorrhachis associated with pneumomediastinum secondary to forceful emesis or barotrauma such as heavy coughing [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] . Other reported etiologies include airway obstruction after foreign body aspiration 3 and physical exertion after recreational drug use (Ecstasy and marijuana) 19 .…”