Traumatic Pneumorrhachis Revisited: A Rare Presentation of Pleurospinal Fistula Tract with Updated Literature Insights.

Pneumorrhachis (PR), defined as the presence of air within the spinal canal, is a rare radiological finding most commonly associated with trauma. While extradural PR is typically considered benign, intradural PR may indicate severe spinal trauma or dural disruption. We present a case of extensive traumatic PR following high-energy spinal injury, accompanied by a comprehensive review of the literature to evaluate the etiology, anatomical distribution, clinical significance and management strategies of PR. We conducted a literature review of 44 PubMed-indexed articles encompassing 153 cases of PR, analyzing trends in etiology, anatomical distribution and clinical outcomes. Traumatic PR accounted for approximately 73.9% of cases, with spontaneous and iatrogenic causes comprising the remainder. The thoracic spine was the most frequently involved region, and extradural and intradural PR were equally represented. Although PR often resolves spontaneously, its presence - especially in the context of trauma - should prompt thorough evaluation for underlying spinal or thoracic injuries. A brief illustrative case of traumatic PR following high-energy spinal injury is presented to provide clinical context.