title: Traumatic pneumorrhachis: etiology, pathomechanism, diagnosis, and treatment.
abstract: BACKGROUND
  Traumatic pneumorrhachis (PR) is a rare entity, consisting of air within the spinal canal. It can be classified as epidural or subarachnoid, identifying the anatomical space where the air is located, and is associated with different etiologies, pathology, and treatments.
  
  
  OBJECTIVE
  To conduct a systematic review of the scientific literature focused on the etiology, pathomechanism, diagnosis, and treatment of PR, and to report a case of an asymptomatic epidural type.
  
  
  METHODS
  International medical literature has been reviewed systematically for the term "traumatic pneumorrhachis" and appropriate related subject headings, such as traumatic intraspinal air, traumatic intraspinal pneumocele, traumatic spinal pneumatosis, traumatic spinal emphysema, traumatic aerorachia, traumatic pneumosaccus, and traumatic air myelogram. All cases that were identified were evaluated concerning their etiology, pathomechanism, and possible complications.
  
  
  METHODS
  Studies that included one of the aforementioned terms in their titles.
  
  
  METHODS
  A systematic review was performed to identify, evaluate, and summarize the literature related to the term "traumatic pneumorrhachis" and related headings. Furthermore, we report a rare case of an asymptomatic epidural PR extending to the cervical and thoracic spinal canal. We present the current data regarding the etiology, pathomechanism, diagnosis, and treatment modalities of patients with PR.
  
  
  RESULTS
  The literature review included 37 related articles that reported 44 cases of traumatic PR. Only isolated case reports and series of no more than three cases were found. In 21 cases, the air was located in the epidural space, and in 23 cases, it was in the subarachnoid space. Most of the cases were localized to a specific spinal region. However, eight cases extending to more than one spinal region have been reported.
  
  
  CONCLUSIONS
  Traumatic PR is an asymptomatic rare clinical entity and often is underdiagnosed. It usually resolves by itself without specific treatment. We stress the significance of this information to trauma specialists, so that they may better differentiate between epidural and subarachnoid PR. This is of great significance because subarachnoid PR is a marker of severe injury. The management of traumatic PR has to be individualized and frequently requires multidisciplinary treatment, involving head, chest, and/or abdomen intervention.
authors.affiliation: Department of Orthopaedics, University Hospital of Ioannina, Leoforos Stavrou Niarchou, Ioannina 45500, Greece.
authors.forename: Ioannis D
authors.initials: ID
authors.lastname: Gelalis
authors.forename: Athanasios
authors.initials: A
authors.lastname: Karageorgos
authors.forename: Christina
authors.initials: C
authors.lastname: Arnaoutoglou
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Gartzonikas
authors.forename: Aggelos
authors.initials: A
authors.lastname: Politis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Georgakopoulos
authors.forename: Adamandios P
authors.initials: AP
authors.lastname: Petsanas
authors.forename: Charalambos
authors.initials: C
authors.lastname: Matzaroglou
authors.forename: Theodoros
authors.initials: T
authors.lastname: Xenakis
mesh_terms: D004646:Emphysema / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy*; D004824:Epidural Space / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D011859:Radiography; D013115:Spinal Canal / Q000000981:diagnostic imaging / Q000473:pathology*; D013122:Spinal Diseases / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy*; D013346:Subarachnoid Space / Q000000981:diagnostic imaging / Q000473:pathology