SHARE @ Advocate Health - Midwest - Scientific Day: Pediatric Pneumorrhachis: A Systematic Review of Literature
 

Affiliations

Advocate Children’s Hospital

Abstract

Background/Significance:

Pneumorrhachis (PR), or air in the spinal canal, is an uncommonly reported radiological finding, especially in pediatrics.

Purpose:

Evidence for evaluation, management and prognosis of pediatric PR is limited to isolated case reports. We reviewed available case reports to identify causes, management, and outcomes of children with PR and expand current literature.

Methods:

We searched PubMed, Embase, and CINAHL databases to identify cases of PR in children less than 18 years of age published in English. We excluded duplicates, animal reports, and articles without an illustrative case of spinal air. “Citationchaser” was used to identify additional articles.

Results:

We identified 110 cases from 1186 articles from the initial search and 6 articles from Citationchaser that met inclusion criteria. Gender was reported in 106, of which 76% (n=81) were males. The median (IQR) age was 12.5 (7-16) years. Lower extremity motor deficits were described in 10 cases (9.09%), including 5 attributed directly to PR, but symptoms in all other cases were related to underlying condition. Etiologies of PR were spontaneous (n=73), traumatic (n=24), iatrogenic (n=11), or other (n=2). Spontaneous PR was most commonly associated with asthma or other respiratory pathology (n=45). Associated air in other locations was noted in 98% (n=72) of patients with spontaneous PR and 17 cases with traumatic PR. PR was identified by computerized tomography (n=103), magnetic resonance imaging (n=3) or radiograph (n=3). Other evaluations included bronchoscopy (n=12), esophagogram (n=17), and echocardiography (n=5). Spontaneous PR resolved with treatment of underlying condition and hyperbaric oxygen therapy was used in one patient. Surgical interventions used in traumatic or iatrogenic PR included chest tube placement (n=4), spinal decompression (n=5), dural tear repair (n=3), and foreign body removal (n=2). The outcome was not reported for 3 patients. Most were discharged home (n=103) without neurologic deficits from PR. Four case subjects, including 3 with neurologic deficits, died from unrelated causes.

Conclusion:

PR is usually an asymptomatic and self-limited condition that resolves with conservative therapy. It can rarely lead to neurologic deficits and may signify major trauma to the head or spine. Evaluations may be required to identify the source of air leak or air entry into the spinal canal. Associated medical conditions usually determine prognosis.

Presentation Notes

Presented at Scientific Day; May 21, 2025; Park Ridge, IL.

Full Text of Presentation

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Poster


 

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May 21st, 11:41 AM May 21st, 1:15 PM

Pediatric Pneumorrhachis: A Systematic Review of Literature

Background/Significance:

Pneumorrhachis (PR), or air in the spinal canal, is an uncommonly reported radiological finding, especially in pediatrics.

Purpose:

Evidence for evaluation, management and prognosis of pediatric PR is limited to isolated case reports. We reviewed available case reports to identify causes, management, and outcomes of children with PR and expand current literature.

Methods:

We searched PubMed, Embase, and CINAHL databases to identify cases of PR in children less than 18 years of age published in English. We excluded duplicates, animal reports, and articles without an illustrative case of spinal air. “Citationchaser” was used to identify additional articles.

Results:

We identified 110 cases from 1186 articles from the initial search and 6 articles from Citationchaser that met inclusion criteria. Gender was reported in 106, of which 76% (n=81) were males. The median (IQR) age was 12.5 (7-16) years. Lower extremity motor deficits were described in 10 cases (9.09%), including 5 attributed directly to PR, but symptoms in all other cases were related to underlying condition. Etiologies of PR were spontaneous (n=73), traumatic (n=24), iatrogenic (n=11), or other (n=2). Spontaneous PR was most commonly associated with asthma or other respiratory pathology (n=45). Associated air in other locations was noted in 98% (n=72) of patients with spontaneous PR and 17 cases with traumatic PR. PR was identified by computerized tomography (n=103), magnetic resonance imaging (n=3) or radiograph (n=3). Other evaluations included bronchoscopy (n=12), esophagogram (n=17), and echocardiography (n=5). Spontaneous PR resolved with treatment of underlying condition and hyperbaric oxygen therapy was used in one patient. Surgical interventions used in traumatic or iatrogenic PR included chest tube placement (n=4), spinal decompression (n=5), dural tear repair (n=3), and foreign body removal (n=2). The outcome was not reported for 3 patients. Most were discharged home (n=103) without neurologic deficits from PR. Four case subjects, including 3 with neurologic deficits, died from unrelated causes.

Conclusion:

PR is usually an asymptomatic and self-limited condition that resolves with conservative therapy. It can rarely lead to neurologic deficits and may signify major trauma to the head or spine. Evaluations may be required to identify the source of air leak or air entry into the spinal canal. Associated medical conditions usually determine prognosis.

 

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