Spontaneous pneumorrhachis in adolescents: illustrative case.
- 1Department of Neurological Surgery, University of Massachusetts Chan Medical School, Worcester.
- 2UMass Memorial Health Center, Worcester, Massachusetts.
Abstract
Background
Spontaneous pneumorrhachis, defined as the presence of air in the spinal canal without trauma or iatrogenic intervention, is rare in adolescents. The clinical course remains anecdotal, and no standardized management guidelines exist. The authors performed the first systematic review focused on adolescent spontaneous pneumorrhachis and describe an illustrative case.Observations
A 16-year-old previously healthy female presented with facial crepitus, intractable vomiting, fever, and streptococcal pharyngitis. Imaging revealed extensive pneumomediastinum, subcutaneous emphysema, and posterior epidural pneumorrhachis spanning from C7 to T8. Given a neurointact examination, conservative management was pursued. A systematic review of the literature assessed predisposing conditions, presenting symptoms, associated radiographic findings, and clinical management.Lessons
Pneumorrhachis should be considered in adolescents presenting with crepitus following vomiting or respiratory illness, particularly when accompanied by facial or cervical swelling. While the clinical course is typically benign, neurosurgical evaluation is valuable in distinguishing this condition from other causes of intraspinal air and to avoid neurological compromise. We propose a focused approach for the management of spontaneous pneumorrhachis in adolescence focused on treating the underlying condition, conservative management when no neurological deficits are present, and close neurological monitoring. https://thejns.org/doi/10.3171/CASE26332.
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BibTeX
@article{paul2026spontaneous,
title = {{Spontaneous pneumorrhachis in adolescents: illustrative case.}},
author = {Umika Paul and Constance Mietus and Brooke Honzel and Stephen Gutting},
journal = {Journal of neurosurgery. Case lessons},
year = {2026},
month = oct,
doi = {10.3171/case26332},
url = {https://europepmc.org/article/MED/42896235},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Spontaneous pneumorrhachis in adolescents: illustrative case.
AU - Umika Paul
AU - Constance Mietus
AU - Brooke Honzel
AU - Stephen Gutting
PY - 2026
DA - 2026/10/19
JO - Journal of neurosurgery. Case lessons
DO - 10.3171/case26332
UR - https://europepmc.org/article/MED/42896235
AB - Background Spontaneous pneumorrhachis, defined as the presence of air in the spinal canal without trauma or iatrogenic intervention, is rare in adolescents. The clinical course remains anecdotal, and no standardized management guidelines exist. The authors performed the first systematic review focused on adolescent spontaneous pneumorrhachis and describe an illustrative case.Observations A 16-year-old previously healthy female presented with facial crepitus, intractable vomiting, fever, and streptococcal pharyngitis. Imaging revealed extensive pneumomediastinum, subcutaneous emphysema, and posterior epidural pneumorrhachis spanning from C7 to T8. Given a neurointact examination, conservative management was pursued. A systematic review of the literature assessed predisposing conditions, presenting symptoms, associated radiographic findings, and clinical management.Lessons Pneumorrhachis should be considered in adolescents presenting with crepitus following vomiting or respiratory illness, particularly when accompanied by facial or cervical swelling. While the clinical course is typically benign, neurosurgical evaluation is valuable in distinguishing this condition from other causes of intraspinal air and to avoid neurological compromise. We propose a focused approach for the management of spontaneous pneumorrhachis in adolescence focused on treating the underlying condition, conservative management when no neurological deficits are present, and close neurological monitoring. https://thejns.org/doi/10.3171/CASE26332.
SN - 2694-1902
ER -