1. ISPRM Symposium on Rehabilitation Disaster Relief at the 6th ISPRM World Conference in Puerto Rico 2011 13 June 2011San Juan Puerto Rico Pneumorrhachis of thoracic spine after gunshot wound Farooq A. Rathore 1 , Zaheer A. Gill 2 , AmjadYasin3 1 Department of Rehabilitation Medicine, Combined Military Hospital, Panoaqil Cantt, 65130 Sindh, Pakistan 2 Spinal Unit, Armed Forces Institute of Rehabilitation Medicine , Abid Majeed Road, Rawalpindi, 46000, Pakistan 3Department of General Surgery, Combined Military Hospital, Rawalpindi 4600, Pakistan. Figures 1 and 2: X ray of the thoracic spine shows communited fracture of the first thoracic vertebrae. There is no mediastinal widening or pneumothorax Introduction Results Results Methods & Materials Introduction Air in the spinal canal is called pneumorrhachis. It is also described as aerorachia, intraspinalpneumocele or pneumomyelogram. It is a rare but documented complication of many traumatic (pneumothorax, blunt chest trauma, spinal fracture, basilar skull fracture, elective cranial surgery) and non traumatic events (vertebral metastases, spontaneous pneumomediastinum, open myelomeningocele). X-rays of the thoracic spine revealed comminuted fracture of first dorsal vertebra (DV1), while X ray chest was negative for pneumothorax or mediastinal widening (Fig 1). The patient underwent CT scan of the cervicodorsalspine. It was suggestive of fracture of spinous process and left lamina of DV1 along with spinal stenosis and air in the spinal canal. (Fig 2) There was no gross spinal instability. Clinically the patient had Spinal cord Injury (SCI) T2 American Spinal Injury Association (ASIA) Impairment Scale-A. Debridement of the gunshot wounds was performed. He was managed conservatively for the spinal fracture and transferred to our rehabilitation unit, two weeks after the injury. He underwent a comprehensive SCI rehabilitation program, which included physical therapy, transfers training, wheel chair mobility skills, occupational therapy, bladder and bowel management as well as counseling sessions. The gunshot wounds healed well and his 6 months stay in the rehabilitation department was uneventful. The air in the spinal canal did not interfere with the mobility or rehabilitation protocols of the patient. A repeat CT scan after two months showed complete resolution of the pneumorrhachis. At one year follow up there is no improvement in the neurological status of the patient and he is wheelchair dependent for mobility. A 32 years old previously healthy male soldier sustained a gunshot wound to lower portion of the neck during a military operation. The bullet entered anteriorelyon the left side of the neck. He had immediate loss of movement in all four limbs along with loss of sensation. He fell down, but did not lose consciousness. He was evacuated to a tertiary care hospital by road. Upon arrival he had stable vital signs with a Glasgow Coma Scale score of 15 and could recount the events leading to his injury. There were no complaints of dysphagia or respiratory difficulty at presentation and during his stay at the rehabilitation department. Case Presentation Figure 3: CT scan ( Axial slice) reveals fracture of spinous process and left lamina of DV1 along with spinal stenosis and presence of multiple air shadows in the spinal canal( Pneumorrchahis) Conclusions Presence of air in spinal canal itself is harmless and absorbs spontaneously in due course of time, yet some patients may require surgical repair of the torn dura mater to prevent bacterial meningitis and stop CSF leakage. However, it should be realized that in a rare number of cases, pneumorrhachis can cause symptoms of cord compression and may even require decompressive surgery. Therefore, prompt evaluation and diagnosis remain important.