Cervical Radiculopathy Due to Epidural Pneumorrhachis Following Degenerative Lumbar Spine Surgery

Iatrogenic pneumorrhachis is a rare, usually asymptomatic phenomenon that is typically detected incidentally. Occasionally, pneumorrhachis has been reported to be associated with acute nerve root compression, chronic radiculopathy, myelopathy, and cauda equina syndrome. Here, we present the case of a 63-year-old woman who underwent lumbar decompressive surgery for spinal stenosis and developed acute-onset neck and bilateral cervical radicular pain while standing on postoperative day 2. This unusual finding was aggravated in the upright position and relieved by recumbency. Her CT examination demonstrated a characteristic tulip-like configuration in the cervical spinal canal, indicative of epidural pneumorrhachis. Following conservative treatment, the patient was discharged after full recovery. Symptomatic epidural pneumorrhachis should be considered in patients who develop otherwise unexplained positional radicular symptoms after spinal surgery. In patients with an incidental durotomy, active subatmospheric drainage should be used cautiously, particularly when cerebrospinal fluid-containing output or new neurological symptoms develop.