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A rare case of spontaneous giant pneumorrachis presenting with cauda equina syndrome: a case report

Spinal Cord Series and Cases volume 10, Article number: 18 (2024) Cite this article

Subjects

Abstract

Introduction

Pneumorrachis is presence of air in the epidural space. It could be the result of trauma, barotrauma, iatrogenic or spontaneous. The pneumorrachis per se is an underdiagnosed entity as most of the patients are asymptomatic or have subclinical symptoms. The spontaneous occurrence of pneumorrachis has been reported in literature but giant spontaneous occurrence causing cauda equina syndrome has not been reported so far.

Case presentation

We report a case of 56-year-old male patient who came to our OPD on wheelchair with complains of difficulty in walking for 6 months with dribbling of urine for 2 months with on and off back pain. His perianal sensation was reduced with absent voluntary anal contraction. Imaging revealed giant air pockets in the spinal canal of L5-S1 extending upto L4-L5. It was managed surgically wherein laminectomy without fusion was done. The patient responded well to the treatment.

Discussion

There are many causes of pneumorrachis described in literature. Most of the cases of pneumorrachis are asymptomatic and incidentally diagnosed. With the improvement in radio-diagnostic modalities, the diagnosis of pneumorrachis can be easily established. When symptomatic, they can be managed conservatively. Those presenting with neurological deficit may require surgical intervention or other invasive intervention.

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Fig. 1: Radiologic evaluation.
Fig. 2: Radiologic evaluation.
Fig. 3: Confirmation of the pathology.

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Data availability

The authors confirm that the data supporting the findings of this study are available with the article and its Supplementary Material. Raw data that support the findings of this study are available from the corresponding author upon reasonable request.

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Author information

Authors and Affiliations

  1. Spine Surgery, Max Super Speciality Hospital, Vaishali, New Delhi, India

    Anuj Gupta

  2. Fellow of National Board, Spine Surgery, Indian Spinal Injuries Centre, New Delhi, India

    Mayukh Guha

  3. Spine Surgery, Indian Spinal Injuries Centre, New Delhi, India

    Kuldeep Bansal

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  1. Anuj Gupta
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  2. Mayukh Guha
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  3. Kuldeep Bansal
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Contributions

KB has designed the study, gathered information and did the final proof reading, AG gathered information, MG gathered information and made the case report.

Corresponding author

Correspondence to Kuldeep Bansal.

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Gupta, A., Guha, M. & Bansal, K. A rare case of spontaneous giant pneumorrachis presenting with cauda equina syndrome: a case report. Spinal Cord Ser Cases 10, 18 (2024). https://doi.org/10.1038/s41394-024-00631-8

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  • DOI: https://doi.org/10.1038/s41394-024-00631-8

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