Symptomatic pneumorrhachis after arthrodesis due to gunshot wounds - A Case Report

Symptomatic pneumorrhachis after arthrodesis due to gunshot wounds - A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Symptomatic pneumorrhachis after arthrodesis due to gunshot wounds - A Case Report Fernanda Frenner, Fernando Antonio Melo Filho, GABRIEL POKORNY, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2648838/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 28 Aug, 2023 Read the published version in SN Comprehensive Clinical Medicine → Version 1 posted 4 You are reading this latest preprint version Abstract Introduction: Pneumorrhachis, is a condition where, air or gas, are entrapped within the spinal canal. Due to its rareness, it can present a diagnostic challenge. Usually, pneumorrhachis represents an asymptomatic epiphenomenon but it can produce symptoms associated with its underlying pathology. Here, we report a rare case of symptomatic epidural pneumorrhachis post arthrodesis in a patient with gunshot wounds to the thoracic spine. Possible pathogenic mechanisms are discussed, and a review of the literature is included. Case presentation: A 28-year-old male patient, victim of a gunshot wound receiving posterior spinal fixation without any intraoperative complication, presents with of intolerable and diffuse pain in the neck and back - making it impossible for him to remain in the supine position, epigastralgia and dysesthesia, especially in the upper limbs and right hemithorax, also reports loss of sensitivity to touch, especially in the distal extremities of the upper limbs. MRI exams shows clear presence of air (hypodense signal) in the treated thoracic region. A hyperbaric chamber was chosen, initially for five sessions, at the end of the five sessions, the patient only complained of dysesthesia and changes in distal fine motor skills, with almost complete recovery of strength. Five more sessions were performed, with total improvement of sensory changes and almost complete recovery of strength. Conclusion: Pneumorrhachis although usually asymptomatic can present in some cases several neurological impairments due to spinal cord compression. Spine trauma Complications Case Report Pneumorrhachis Figures Figure 1 Figure 2 Figure 3 Introduction Pneumorrhachis is defined as the presence of air within the intradural or extradural compartments of the spinal canal[ 1 ]. Air within the epidural space is also referred to as epidural emphysema or epidural pneumorrhachis and has been described associated with several other conditions and causes [ 2 – 6 ]. Occurrence of pneumorrhachis is frequently asymptomatic and does not require any specific treatment because air is reabsorbed spontaneously without leaving any neurological sequela[ 4 , 7 ]. The onset of symptoms in pneumorrhachis cases are very rare, however when they occur it could causa discomfort and/or pain, and even neurological deficits [ 7 – 9 ]. And although, cases of pneumorrhachis are mainly treated with conservative approaches, in some cases measures are needed to treat the entity that is causing the pneumorrhachis[ 8 ] Here, we report a rare case of symptomatic epidural pneumorrhachis post arthrodesis in a patient with gunshot wounds to the thoracic spine. Case Report A 28-year-old male patient, victim of a gunshot wound to the thoracic spine (T9), arrived at our service already paraplegic (ASIA A, with sensitive level in T8) (Fig. 1 ). At this moment, was decided to perform arthrodesis to stabilize the fracture, avoiding kyphotization and long-term pain. The patient remained hospitalized for seven days and was discharged without further complaints. He remained stable and under outpatient follow-up for two months after the surgery, returning to our emergency room with a complaint of intolerable and diffuse pain in the neck and back - making it impossible for him to remain in the supine position, epigastralgia and dysesthesia, especially in the upper limbs and right hemithorax. He also reported loss of sensitivity to touch, especially in the distal extremities of the upper limbs. In the initial evaluation, a contained fistula was identified, with an operative scar in good appearance, without phlogistic signs or secretions coming out. The patient developed tetraparesis, losing strength in the upper limbs - worse on the right and with reduced fine motor coordination. Cervicothoracic spine tomography showed extensive pneumorrhachis extending from C2 to T10 and excessively compressing the spinal cord (Fig. 2 ). A hyperbaric chamber was chosen, initially for five sessions, with clinical improvement of symptoms reported since the first session. At the control tomography after the fourth session, a clear reabsorption of gas in the spinal canal could be seen, in the region of the thoracic spine (Fig. 3 ). At the end of the five sessions, the patient only complained of dysesthesia and changes in distal fine motor skills, with almost complete recovery of strength. Five more sessions were performed, with total improvement of sensory changes and almost complete recovery of strength. Discussion Pneumorrhachia is defined as the presence of air in the spinal canal and is also referred to as epidural emphysema or epidural pneumorrhachia and can occur due to several factors[ 1 , 6 ]. Here we report a case of a pneumorrhachis occurring after a posterior spinal fixation to treat a victim of gunshot wounds. The occurrence of pneumorrhachis is rare and usually it occurs in an asymptomatic fashion [ 7 , 8 ]. Regarding the presence of pneumorrhachis due to arthrodesis there are very few reports in the literature. Karavelioglu, et al, 2014 reported a case of pneumocephalus, and reviewed the literature, founding only other six cases reporting pneumocephalus after spinal surgery[ 5 ]. Considering only pneumorrhachis, one article reported the occurrence of pneumorrhachis after spinal fusion, the authors reported that during a scoliosis correction procedure, the evoked-potentials signal were almost lost due to the presence of an intradural pneumorrhachis[ 10 ]. Further, another study reported that the occurrence of a delayed presentation of both pneumorrhachis and pneumocephalus due to the presence of CSF leak[ 11 ]. Finally, Bautista et al, 2021 reported the occurrence of a pneumorrhachis after a cervical spinal surgery procedure[ 12 ]. Although, the specific cause of the air influx into the canal are no very well stablished, the leading hypothesis is that it could occur after small dural injuries unperceived during the spinal procedure[ 12 ]. When presented with a symptomatic case of pneumorrhachis, the team must try to identify the possible causing agent, to remove it, or treat it with antibiotics, allied with hydration, bed-rest and correct positioning to avoid headaches and couching[ 12 ]. Another crucial factor to access when dealing with a pneumorrhachis is the location of the entrapped air, as the clinical consequences of epidural pneumorrhachia and subarachnoid pneumorrhachis are different from each other. According to a previous case report, the first is innocuous and self-limiting, while the second can be complicated by tension pneumocephalus and meningitis[ 2 , 8 , 12 ]. Further, is important to conduct a thorough and daily neurological examination to evaluate and detect any changes that may indicate neurological deterioration due to an increase in the collection of air in the spinal canal - and if this occurs, it is indicative to perform a new image exam immediately[ 1 , 2 ]. The diagnosis is made through imaging tests such as computed tomography, magnetic resonance imaging or radiography. Most of the cases described had conservative treatment and continuous monitoring of the patient, with serial neurological assessment [ 1 , 2 , 8 ]. However, there is no definitive method of treatment and course of evolution. In the present report the patient in evolved with a slowly progressive and asymmetrical improvement in symptoms as the air collection was being absorbed - initially from paresthesia and later also from paresis of the upper limbs and was discharged with almost complete improvement of the neurological deficits after 4 weeks, after performing a total of ten sessions in a hyperbaric chamber. In association with the treatment of pneumorrhachis, the patient started using pregabalin to help with dysesthetic symptoms. Conclusion We describe a rare case of symptomatic epidural pneumorrhachis after arthrodesis in a patient with gunshot wounds to the thoracic spine. Although infrequent and very rarely symptomatic, surgeon must be aware of the signals, both clinical and imagological, of pneumorrhachis given its potential to cause neurological damage through spinal cord compression. Declarations 1. Funding (information that explains whether and by whom the research was supported): Not applicable 2. Conflicts of interest/Competing interests (include appropriate disclosures): Not applicable 3. Ethics approval (include appropriate approvals or waivers): Not applicable 4. Consent to participate (include appropriate statements): The patient consented in have his images and information collected 5. Written Consent for publication (include appropriate statements): The patient consented in have his images and information collected 6. Availability of data and material (data transparency): Not applicable 7. Code availability (software application or custom code): Not applicable 8. Authors' contributions: FF: Conceptualization, Investigation, Writing - original draft. GH: Writing - original draft , Visualization: Conceptualization, BSB: Conceptualization, Methodology, Formal analysis, Writing - review & editing, Project administration, Supervision. FAMF: Conceptualization, Methodology, Formal analysis, Writing - review & editing, Project administration, Supervision. References Oertel MF, Korinth MC, Reinges MHT, Krings T, Terbeck S, Gilsbach JM. Pathogenesis, diagnosis and management of pneumorrhachis. Eur Spine J. 2006;15:636. Vanmali A, Daji KD. Pneumorrhachis: An uncommon radiological entity. SA J Radiol. 2021. https://doi.org/10.4102/SAJR.V25I1.2255 . Derakhshan N, Baghban F, Haghnegahdar A. Cervical Pneumorrhachis. Bull Emerg Trauma. 2013;1:186. Pfeifle C, Henkelmann R, von der Höh N, Jarvers JS, Spiegl U, Josten C, Heyde CE. Traumatic pneumorrhachis. Injury. 2020;51:267–70. Karavelioglu E, Eser O, Haktanir A. Pneumocephalus and Pneumorrhachis after Spinal Surgery: Case Report and Review of the Literature. Neurol Med Chir (Tokyo). 2014;54:405. Osunronbi T, Sofela A, Sharma H, Muquit S. Traumatic pneumorrhachis: systematic review and an illustrative case. Neurosurg Rev. 2021;44:731–9. Koktekir E, Tatarli N, Ceylan D, Koktekir BE, Akdemir G. Symptomatic pneumorrhachis. J Neurol Surg A Cent Eur Neurosurg. 2014;75:140–5. Kim SW, Seo HJ. Symptomatic Epidural Pneumorrhachis: A Rare Entity. J Korean Neurosurg Soc. 2013;54:65. Krishna P, Gupta M. Symptomatic Pneumorrhachis After an Epidural Blood Patch. J Emerg Med. 2015;49:e49–e52. Bhat SB, Blumer S, Shah SA. (2017) Epidural Pneumorrhachis Causing Intraoperative Loss of Motor Potentials During Instrumented Fusion for Scoliosis: A Case Report. JBJS Case Connect. https://doi.org/10.2106/JBJS.CC.16.00191 Kieser DC, Cawley DT, Tavolaro C, Cloche T, Roscop C, Boissiere L, Obeid I, Pointillart V, Vital JM, Gille O. Delayed post-operative tension pneumocephalus and pneumorrhachis. Eur Spine J. 2018;27:231–5. Bautista M, Wright J, Pippalapalli J, Schramm MWJ, Anderson IA, Pandit MH. Pneumorrhachis following cervical spine surgery. Anaesth Rep. 2021. https://doi.org/10.1002/ANR3.12137 . Supplementary Files CAREChecklist.docx Cite Share Download PDF Status: Published Journal Publication published 28 Aug, 2023 Read the published version in SN Comprehensive Clinical Medicine → Version 1 posted Reviewers agreed at journal 02 May, 2023 Reviewers invited by journal 14 Apr, 2023 Editor assigned by journal 14 Apr, 2023 First submitted to journal 13 Apr, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2648838","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":191932457,"identity":"ffffe3ca-06a4-4514-b86c-eff34385d81f","order_by":0,"name":"Fernanda Frenner","email":"","orcid":"","institution":"Hospital Municipal Mario Gatti","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Fernanda","middleName":"","lastName":"Frenner","suffix":""},{"id":191932458,"identity":"553e7da4-a645-4a16-b22a-30ea27fd6bb7","order_by":1,"name":"Fernando Antonio Melo Filho","email":"","orcid":"","institution":"Hospital 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14:53:11","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":318667,"visible":true,"origin":"","legend":"\u003cp\u003eCT showing the presence of bullets fragments in the T8/T9 level.\u003c/p\u003e","description":"","filename":"Slide1.png","url":"https://assets-eu.researchsquare.com/files/rs-2648838/v1/38229292fdc01b543f33a09e.png"},{"id":35880184,"identity":"c508b2a2-35b3-4645-91c6-f9f533ef48fb","added_by":"auto","created_at":"2023-04-17 14:53:11","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":366244,"visible":true,"origin":"","legend":"\u003cp\u003eCT scans evidencing the presence of pneumorrhachis at the intrumentated levels and above.\u003c/p\u003e","description":"","filename":"Slide2.png","url":"https://assets-eu.researchsquare.com/files/rs-2648838/v1/6f7d6356ff17599dc13d342d.png"},{"id":35880182,"identity":"fad39e3f-df62-4fe8-b25b-8bfe1b8b313c","added_by":"auto","created_at":"2023-04-17 14:53:11","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":291161,"visible":true,"origin":"","legend":"\u003cp\u003eCT scans showing the complete resolution of the pneumorrhachis in the thoracic spine and almost complete resolution in the cervical spine.\u003c/p\u003e","description":"","filename":"Slide3.png","url":"https://assets-eu.researchsquare.com/files/rs-2648838/v1/084c35b1d727bcc2d5bce273.png"},{"id":42781872,"identity":"65892c07-2cee-4ff8-98e6-7a781895620b","added_by":"auto","created_at":"2023-09-07 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compartments of the spinal canal[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Air within the epidural space is also referred to as epidural emphysema or epidural pneumorrhachis and has been described associated with several other conditions and causes [\u003cspan additionalcitationids=\"CR3 CR4 CR5\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOccurrence of pneumorrhachis is frequently asymptomatic and does not require any specific treatment because air is reabsorbed spontaneously without leaving any neurological sequela[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The onset of symptoms in pneumorrhachis cases are very rare, however when they occur it could causa discomfort and/or pain, and even neurological deficits [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAnd although, cases of pneumorrhachis are mainly treated with conservative approaches, in some cases measures are needed to treat the entity that is causing the pneumorrhachis[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eHere, we report a rare case of symptomatic epidural pneumorrhachis post arthrodesis in a patient with gunshot wounds to the thoracic spine.\u003c/p\u003e"},{"header":"Case Report","content":"\u003cp\u003eA 28-year-old male patient, victim of a gunshot wound to the thoracic spine (T9), arrived at our service already paraplegic (ASIA A, with sensitive level in T8) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). At this moment, was decided to perform arthrodesis to stabilize the fracture, avoiding kyphotization and long-term pain. The patient remained hospitalized for seven days and was discharged without further complaints.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eHe remained stable and under outpatient follow-up for two months after the surgery, returning to our emergency room with a complaint of intolerable and diffuse pain in the neck and back - making it impossible for him to remain in the supine position, epigastralgia and dysesthesia, especially in the upper limbs and right hemithorax. He also reported loss of sensitivity to touch, especially in the distal extremities of the upper limbs. In the initial evaluation, a contained fistula was identified, with an operative scar in good appearance, without phlogistic signs or secretions coming out. The patient developed tetraparesis, losing strength in the upper limbs - worse on the right and with reduced fine motor coordination. Cervicothoracic spine tomography showed extensive pneumorrhachis extending from C2 to T10 and excessively compressing the spinal cord (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eA hyperbaric chamber was chosen, initially for five sessions, with clinical improvement of symptoms reported since the first session. At the control tomography after the fourth session, a clear reabsorption of gas in the spinal canal could be seen, in the region of the thoracic spine (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). At the end of the five sessions, the patient only complained of dysesthesia and changes in distal fine motor skills, with almost complete recovery of strength. Five more sessions were performed, with total improvement of sensory changes and almost complete recovery of strength.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePneumorrhachia is defined as the presence of air in the spinal canal and is also referred to as epidural emphysema or epidural pneumorrhachia and can occur due to several factors[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Here we report a case of a pneumorrhachis occurring after a posterior spinal fixation to treat a victim of gunshot wounds.\u003c/p\u003e \u003cp\u003eThe occurrence of pneumorrhachis is rare and usually it occurs in an asymptomatic fashion [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Regarding the presence of pneumorrhachis due to arthrodesis there are very few reports in the literature. Karavelioglu, et al, 2014 reported a case of pneumocephalus, and reviewed the literature, founding only other six cases reporting pneumocephalus after spinal surgery[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Considering only pneumorrhachis, one article reported the occurrence of pneumorrhachis after spinal fusion, the authors reported that during a scoliosis correction procedure, the evoked-potentials signal were almost lost due to the presence of an intradural pneumorrhachis[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Further, another study reported that the occurrence of a delayed presentation of both pneumorrhachis and pneumocephalus due to the presence of CSF leak[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Finally, Bautista et al, 2021 reported the occurrence of a pneumorrhachis after a cervical spinal surgery procedure[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Although, the specific cause of the air influx into the canal are no very well stablished, the leading hypothesis is that it could occur after small dural injuries unperceived during the spinal procedure[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhen presented with a symptomatic case of pneumorrhachis, the team must try to identify the possible causing agent, to remove it, or treat it with antibiotics, allied with hydration, bed-rest and correct positioning to avoid headaches and couching[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Another crucial factor to access when dealing with a pneumorrhachis is the location of the entrapped air, as the clinical consequences of epidural pneumorrhachia and subarachnoid pneumorrhachis are different from each other. According to a previous case report, the first is innocuous and self-limiting, while the second can be complicated by tension pneumocephalus and meningitis[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFurther, is important to conduct a thorough and daily neurological examination to evaluate and detect any changes that may indicate neurological deterioration due to an increase in the collection of air in the spinal canal - and if this occurs, it is indicative to perform a new image exam immediately[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The diagnosis is made through imaging tests such as computed tomography, magnetic resonance imaging or radiography. Most of the cases described had conservative treatment and continuous monitoring of the patient, with serial neurological assessment [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, there is no definitive method of treatment and course of evolution. In the present report the patient in evolved with a slowly progressive and asymmetrical improvement in symptoms as the air collection was being absorbed - initially from paresthesia and later also from paresis of the upper limbs and was discharged with almost complete improvement of the neurological deficits after 4 weeks, after performing a total of ten sessions in a hyperbaric chamber. In association with the treatment of pneumorrhachis, the patient started using pregabalin to help with dysesthetic symptoms.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWe describe a rare case of symptomatic epidural pneumorrhachis after arthrodesis in a patient with gunshot wounds to the thoracic spine. Although infrequent and very rarely symptomatic, surgeon must be aware of the signals, both clinical and imagological, of pneumorrhachis given its potential to cause neurological damage through spinal cord compression.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e1. Funding (information that explains whether and by whom the research was supported): \u003c/strong\u003eNot applicable\u003cstrong\u003e\u003cbr /\u003e 2. Conflicts of interest/Competing interests (include appropriate disclosures): \u003c/strong\u003eNot applicable\u003cstrong\u003e\u003cbr /\u003e 3. Ethics approval (include appropriate approvals or waivers): \u003c/strong\u003eNot applicable\u003cstrong\u003e\u003cbr /\u003e 4. Consent to participate (include appropriate statements): \u003c/strong\u003eThe patient consented in have his images and information collected\u003cstrong\u003e\u003cbr /\u003e 5. Written Consent for publication (include appropriate statements): \u003c/strong\u003eThe patient consented in have his images and information collected\u003cstrong\u003e\u003cbr /\u003e 6. Availability of data and material (data transparency): \u003c/strong\u003eNot applicable\u003cstrong\u003e\u003cbr /\u003e 7. Code availability (software application or custom code): \u003c/strong\u003eNot applicable\u003cstrong\u003e\u003cbr /\u003e 8. Authors' contributions: \u003c/strong\u003eFF: Conceptualization, Investigation, Writing - original draft. GH: Writing - original draft , Visualization: Conceptualization, BSB: Conceptualization, Methodology, Formal analysis, Writing - review \u0026amp; editing, Project administration, Supervision. FAMF: Conceptualization, Methodology, Formal analysis, Writing - review \u0026amp; editing, Project administration, Supervision.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eOertel MF, Korinth MC, Reinges MHT, Krings T, Terbeck S, Gilsbach JM. Pathogenesis, diagnosis and management of pneumorrhachis. Eur Spine J. 2006;15:636.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVanmali A, Daji KD. Pneumorrhachis: An uncommon radiological entity. 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Anaesth Rep. 2021. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/ANR3.12137\u003c/span\u003e\u003cspan address=\"10.1002/ANR3.12137\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"sn-comprehensive-clinical-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sncm","sideBox":"Learn more about [SN Comprehensive Clinical Medicine](https://www.springer.com/journal/42399)","snPcode":"42399","submissionUrl":"https://submission.nature.com/new-submission/42399/3","title":"SN Comprehensive Clinical Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Spine trauma, Complications, Case Report, Pneumorrhachis","lastPublishedDoi":"10.21203/rs.3.rs-2648838/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2648838/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePneumorrhachis, is a condition where, air or gas, are entrapped within the spinal canal. Due to its rareness, it can present a diagnostic challenge. Usually, pneumorrhachis represents an asymptomatic epiphenomenon but it can produce symptoms associated with its underlying pathology. Here, we report a rare case of symptomatic epidural pneumorrhachis post arthrodesis in a patient with gunshot wounds to the thoracic spine. Possible pathogenic mechanisms are discussed, and a review of the literature is included.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase presentation: \u003c/strong\u003eA 28-year-old male patient, victim of a gunshot wound receiving posterior spinal fixation without any intraoperative complication, presents with of intolerable and diffuse pain in the neck and back - making it impossible for him to remain in the supine position, epigastralgia and dysesthesia, especially in the upper limbs and right hemithorax, also reports loss of sensitivity to touch, especially in the distal extremities of the upper limbs. MRI exams shows clear presence of air (hypodense signal) in the treated thoracic region. A hyperbaric chamber was chosen, initially for five sessions, at the end of the five sessions, the patient only complained of dysesthesia and changes in distal fine motor skills, with almost complete recovery of strength. Five more sessions were performed, with total improvement of sensory changes and almost complete recovery of strength.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003ePneumorrhachis although usually asymptomatic can present in some cases several neurological impairments due to spinal cord compression.\u003c/p\u003e","manuscriptTitle":"Symptomatic pneumorrhachis after arthrodesis due to gunshot wounds - A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-04-17 14:53:06","doi":"10.21203/rs.3.rs-2648838/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2023-05-02T13:20:47+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-04-14T14:32:05+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-04-14T05:33:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"SN Comprehensive Clinical Medicine","date":"2023-04-13T11:31:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"sn-comprehensive-clinical-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sncm","sideBox":"Learn more about [SN Comprehensive Clinical Medicine](https://www.springer.com/journal/42399)","snPcode":"42399","submissionUrl":"https://submission.nature.com/new-submission/42399/3","title":"SN Comprehensive Clinical Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"4e022d5a-c234-49a4-b5cd-03fa25db661e","owner":[],"postedDate":"April 17th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-09-07T15:11:14+00:00","versionOfRecord":{"articleIdentity":"rs-2648838","link":"https://doi.org/10.1007/s42399-023-01549-2","journal":{"identity":"sn-comprehensive-clinical-medicine","isVorOnly":false,"title":"SN Comprehensive Clinical Medicine"},"publishedOn":"2023-08-28 15:08:30","publishedOnDateReadable":"August 28th, 2023"},"versionCreatedAt":"2023-04-17 14:53:06","video":"","vorDoi":"10.1007/s42399-023-01549-2","vorDoiUrl":"https://doi.org/10.1007/s42399-023-01549-2","workflowStages":[]},"version":"v1","identity":"rs-2648838","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2648838","identity":"rs-2648838","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}