Traumatic Pneumorrhachis-‘When the air hits the spine’

The presence of air within the spinal canal, whether extradural or intradural in location, is known as pneumorrhachis. Traumatic Pneumorrhachis (tPR) may be caused by direct or indirect trauma to the spine, and the intradural type is often associated with severe underlying injuries [ 1 ]. It is usually asymptomatic; however, it may present clinically as compressive myelopathy [ 2 ] and is prone to be missed in the absence of overt spinal cord injury. In a recent systematic review, sensory-motor deficits were directly attributed to tPR in 9% of patients; of these, myelopathy contributed 6% [ 3 ]. I present two cases of tPR patients with contrasting clinical findings and radiology. Interestingly, one patient with a small amount of air presented clinically with myelopathy. In contrast, the other patient, with a larger amount of air, was asymptomatic. These cases suggest that the amount of air is not directly proportional to the clinical symptomatology, and occasionally, small air foci may cause significant cord compression.