Symptomatic Epidural Pneumorrhachis : A Rare Entity
A 50-year-old man was admitted to our emergency department with blunt neck and thoracic trauma caused by a falling tree. On arrival, he was alert and his Glasgow Coma Scale point was 15. His vital signs were stable and electrocardiography, blood cell count, and serum biochemistry were unremarkable. He had full strength in his bilateral upper and lower extremities and he was able to move without limitation. However, he complained of intolerable, diffuse pain in his neck and back with reduced sensation to light touch in all extremities. There was decreased temperature and pinprick in his upper and lower extrimities bilaterally, below the C5 level. Brain computed tomography (CT) revealed no evidence of any abnormality. However, thoracic CT revealed a basal lung contusion and left pneumothorax with multiple fractures of third, fourth, fifth, and sixth ribs, and cervicothoracic spine CT showed extensive pneumorrhachis extending from C4 to T8 and compressing the spinal cord excessively (). Nonetheless, there was no evidence of fracture or subluxation within the spine. A thoracostomy tube was promptly inserted and he was transferred to our intensive care unit for close observation. Conservative treatment including bed rest, O2 inhalation, and medication for pain relief was administered for 7 days, when he was stable and able to tolerate an oral diet. On the 14th day after admission, CT of the cervicothoracic spine was normal and demonstrated complete resolution of the air within the spinal canal with no further complication (). The patient was discharged of 18 days after admission. At the time of discharge, his neurologic examination was unremarkable, and he had full strength in all extremities and an intact sensation to light touch without pain.