Introduction

Pneumorrachis is presence of air in the epidural space. It could be the result of trauma, barotrauma, iatrogenic or spontaneous. The pneumorrachis per se is an underdiagnosed entity as most of the patients are asymptomatic or have subclinical symptoms. The spontaneous occurrence of pneumorrachis has been reported in literature but giant spontaneous occurrence causing cauda equina syndrome has not been reported so far.

Case presentation

We report a case of 56-year-old male patient who came to our OPD on wheelchair with complains of difficulty in walking for 6 months with dribbling of urine for 2 months with on and off back pain. His perianal sensation was reduced with absent voluntary anal contraction. Imaging revealed giant air pockets in the spinal canal of L5-S1 extending upto L4-L5. It was managed surgically wherein laminectomy without fusion was done. The patient responded well to the treatment.

Discussion

There are many causes of pneumorrachis described in literature. Most of the cases of pneumorrachis are asymptomatic and incidentally diagnosed. With the improvement in radio-diagnostic modalities, the diagnosis of pneumorrachis can be easily established. When symptomatic, they can be managed conservatively. Those presenting with neurological deficit may require surgical intervention or other invasive intervention.

中文翻译：

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伴有马尾综合征的自发性巨大气管罕见病例：病例报告

 介绍

气管是指硬膜外腔内存在空气。它可能是外伤、气压伤、医源性或自发性的结果。气管本身是一种未被充分诊断的疾病，因为大多数患者没有症状或有亚临床症状。文献报道自发发生气管，但巨大自发发生引起马尾综合征的报道尚未见报道。

 案例展示

我们报告一例 56 岁男性患者，他坐在轮椅上来到我们的 OPD，主诉 6 个月内行走困难，2 个月内滴尿，伴有时断时续的背痛。由于缺乏自主肛门收缩，他的肛周感觉减弱。影像显示 L5-S1 椎管内有巨大的气穴，一直延伸到 L4-L5。通过手术进行治疗，其中进行了不融合的椎板切除术。患者对治疗反应良好。

 讨论

文献中描述了许多引起气管的原因。大多数气管病例是无症状的，是偶然被诊断出来的。随着放射诊断方式的改进，气管的诊断可以很容易地确定。当出现症状时，可以采取保守治疗。那些出现神经功能缺损的患者可能需要手术干预或其他侵入性干预。