(736) Pediatric Pneumorrhachis: A Systematic Review of Literature

Introduction: Pneumorrhachis (PR), or air in the spinal canal, is an uncommonly reported radiological finding, especially in pediatrics. Evidence for evaluation, management, and prognosis is limited to isolated case reports. We reviewed the literature to identify the causes, management, and outcomes of children with PR.

Methods: We searched PubMed, Embase, and CINAHL databases to identify cases of PR in children less than 18 years of age published in English. We excluded duplicates, animal reports, and articles without an illustrative case of spinal air. “Citationchaser” was used to identify additional articles.

Results: We identified 106 cases from 1186 articles from the initial search and 5 articles from Citationchaser that met inclusion criteria. Gender was reported in 102, of which 73% (n=77) were males. The median (IQR) age was 12 (7-16) years. Lower extremity motor deficits were described in 5 cases (4.7%), but symptoms in all other cases were related to underlying condition. Etiologies of PR were spontaneous (n=69), traumatic (n=24), iatrogenic (n=11), or other (n=2). Spontaneous PR was most commonly associated with asthma or other respiratory pathology (n=42). Associated air in other locations was noted in 99% (n=68) of patients with spontaneous PR and 17 cases with traumatic PR. PR was identified by computerized tomography (n=99), magnetic resonance imaging (n=3) or radiograph (n= 3). Other evaluations included bronchoscopy (n=12), esophagogram (n=17), and esophageal endoscopy (n=2). Spontaneous PR resolved with treatment of underlying condition and hyperbaric oxygen therapy was used in one patient. Surgical interventions used in traumatic or iatrogenic PR included chest tube placement (n=4), spinal decompression (n=5), dural tear repair (n=3), and foreign body removal (n=3). The outcome was not reported for 3 patients. Most were discharged home (n=99) without neurodeficits from PR. Four, including 1 with neuro deficits, died from unrelated causes.

Conclusions: PR is usually an asymptomatic and self-limited condition that resolves with conservative therapy. It can rarely lead to neuro deficits and may signify major trauma to the head or spine. Evaluations may be required to identify the source of air leak or air entry into the spinal canal. Associated medical conditions usually determine prognosis.