rathore pneumorrhachis of the thoracic spine after gunshot wound crdr.disaster.symp.poster.isprm11
DESCRIPTION
TRANSCRIPT
Introduction
Methods & Materials
Results
Conclusions
Air in the spinal canal is called
pneumorrhachis. It is also described as
aerorachia, intraspinal pneumocele or
pneumomyelogram. It is a rare but
documented complication of many
traumatic (pneumothorax, blunt chest
trauma, spinal fracture, basilar skull
fracture, elective cranial surgery) and non
traumatic events (vertebral metastases,
spontaneous pneumomediastinum, open
myelomeningocele ).
X-rays of the thoracic spine revealed
comminuted fracture of first dorsal vertebra
(DV1), while X ray chest was negative for
pneumothorax or mediastinal widening (Fig
1). The patient underwent CT scan of the
cervicodorsal spine. It was suggestive of
fracture of spinous process and left lamina
of DV1 along with spinal stenosis and air in
the spinal canal. (Fig 2) There was no gross
spinal instability.
Clinically the patient had Spinal cord Injury
(SCI) T2 American Spinal Injury Association
(ASIA) Impairment Scale-A. Debridement of
the gunshot wounds was performed. He was
managed conservatively for the spinal
fracture and transferred to our rehabilitation
unit, two weeks after the injury. He
underwent a comprehensive SCI
rehabilitation program, which included
physical therapy, transfers training, wheel
chair mobility skills, occupational therapy,
bladder and bowel management as well as
counseling sessions.
The gunshot wounds healed well and his 6
months stay in the rehabilitation
department was uneventful. The air in the
spinal canal did not interfere with the
mobility or rehabilitation protocols of the
patient. A repeat CT scan after two
months showed complete resolution of the
pneumorrhachis. At one year follow up
there is no improvement in the
neurological status of the patient and he
is wheelchair dependent for mobility.
A 32 years old previously healthy male
soldier sustained a gunshot wound to lower
portion of the neck during a military
operation. The bullet entered anteriorely on
the left side of the neck. He had immediate
loss of movement in all four limbs along with
loss of sensation. He fell down, but did not
lose consciousness. He was evacuated to a
tertiary care hospital by road. Upon arrival
he had stable vital signs with a Glasgow
Coma Scale score of 15 and could recount
the events leading to his injury. There were
no complaints of dysphagia or respiratory
difficulty at presentation and during his stay
at the rehabilitation department.
Presence of air in spinal canal itself is
harmless and absorbs spontaneously in due
course of time, yet some patients may
require surgical repair of the torn dura mater
to prevent bacterial meningitis and stop CSF
leakage. However, it should be realized that
in a rare number of cases, pneumorrhachis
can cause symptoms of cord compression
and may even require decompressive
surgery. Therefore, prompt evaluation and
diagnosis remain important.
Figures 1 and 2: X ray of the thoracic spine shows communited fracture of the first thoracic vertebrae. There is no mediastinal widening or
pneumothorax
Pneumorrhachis of thoracic spine after gunshot wound
Farooq A. Rathore 1 , Zaheer A. Gill 2 , Amjad Yasin 3
1 Department of Rehabilitation Medicine, Combined Military Hospital, Panoaqil Cantt, 65130 Sindh, Pakistan
2 Spinal Unit, Armed Forces Institute of Rehabilitation Medicine , Abid Majeed Road, Rawalpindi, 46000, Pakistan
3Department of General Surgery, Combined Military Hospital, Rawalpindi 4600, Pakistan.
ISPRM Symposium on Rehabilitation Disaster Relief at the 6th ISPRM World Conference in Puerto Rico 2011
13 June 2011San Juan Puerto Rico
Introduction Results
Case Presentation
Figure 3: CT scan ( Axial slice) reveals fracture of spinous process and left lamina of DV1 along with spinal stenosis and presence of multiple
air shadows in the spinal canal( Pneumorrchahis)