Pain in the air: successful computed tomography-guided aspiration in a case of spontaneous pneumorrhachis.

Spontaneous pneumorrhachis (air in the spinal canal) occurs in the absence of medical procedures, trauma, or free air distributions in other body compartments (such as pneumomediastinum or pneumothorax) [1]. One postulated cause is the migration of air from the disc into the spinal canal and neural foramina [1] and [2]. A 46-year-old man presented with severe, debilitating pain down the right leg after trivial trauma. Magnetic resonance imaging showed typical degenerative changes of the lumbar spine with narrowing of the L5/S1 disc space and vacuum phenomenon of the disc. A tubular pocket of air was seen in the right lateral recess and exit foramen of L5/S1 with smaller air pockets in the spinal canal posterior to the L5/S1 disc (Fig. 1). A computed tomography scan confirmed air in the right neural foramen and spinal canal (Fig. 2). Under computed tomography guidance, a 20-gauge spinal needle was inserted into the neural foramen, and the air was aspirated (Fig. 3). The patient experienced instant relief, which was maintained at 6-month follow-up.