Objective:

To report on a rare case of cervicothoracolumbar pneumorrachis following an epidural catheter placement.

Background:

Pneumorrachis or epidural emphysema is defined as free air or a gaseous collection in the spinal canal, usually limited to a few vertebral spaces. It is a relatively uncommon condition, and the main causes can be nontraumatic, traumatic, or iatrogenic. To date, there are several cases reported in the literature, but to our knowledge, there are only 2 cases involving the entire spinal cord. There are no reported cases of association with seizure-like activity.

Design/Methods:

Not applicable.

Results:

A 19-year-old healthy G1P0 female admitted for term induction of labor underwent urgent C-section for fetal malposition. Patient had a continuous labor epidural catheter placed without apparent complication. After 45 minutes of recovery in the PACU, patient had seizure-like activity lasting 1 minute. Rapid response and stroke code were both activated. CT imaging of the head and neck noted a lengthy column of air along the entire epidural space of the cervical and thoracic region causing mild mass effect on the spinal cord from C5 to T1. Additionally, there is a small amount of air in the paraspinal soft tissue extending into the occiput on the left and bilateral supraclavicular soft tissue extending into the left axilla. It is assumed that free air also tracked into the lumbar region. Repeat CT of the C, T, and L-spine obtained approximately 24 hours later showed improvement of the epidural emphysema with CT L-spine still showing a noticeable amount of air in the epidural space. All imaging available upon request.

Conclusions:

Patient denied neck or back pain, and neurologic exam was normal. Therefore, she was treated conservatively. She had no recurrence of seizure-like activity and was discharged home 3 days later.