• Songning Fu, Lu Liu, Yadong Liu, and Feng Xu.
• Department of Spine Surgery, The First Hospital of Jilin University.
• Medicine (Baltimore). 2024 Dec 20; 103 (51): e41012e41012.

RationalePneumorachis is an uncommon lesion of the spinal canal, which is often asymptomatic. The pathogenesis and treatment strategies are uncertain because only a few cases have been reported. Some patients were treated with percutaneous aspiration or percutaneous endoscopic treatment, but poor pain release and symptom recurrence were observed. Some patients were treated with open surgery and completely cystectomy and had good clinical outcomes. This article reports a case of pneumorachis resembling lumbar disc herniation combined with lumbar spinal stenosis, in which the patient's compressive symptoms were completely alleviated through open surgery.Patient ConcernsA-56-year-old patient has a 1-year history of radicular pain in the left leg. Magnetic resonance imaging prior to surgery showed a low-signal mass, like a sequestrated disc, in the epidural space at the level of L4 left recess and lumbar spinal stenosis of L4-5 level on both sides. There was a disc-like lesion located at the L4 recess. Computed tomography (CT) showed a homogeneous pneumorachis with a clear boundary. The patient underwent open surgery. Postoperative CT showed that the lumbar canal was decompressed, and this patient was free from pain.DiagnosesL4-5 lumbar canal stenosis, pneumorrhachis.InterventionsFor treatment, the patient underwent open surgery to decompress the lumbar canal stenosis.OutcomesPostoperative CT demonstrated complete decompression of the L4-5 spinal canal, resulting in immediate relief of the patient's nerve root pain. At the 3-month follow-up after surgery, the patient remained pain-free.LessonsFor patients with suspected spinal pneumatosis, CT scans hold significant value to distinguish air and bones from soft-tissue lesions. Furthermore, in this case, we have demonstrated the effectiveness of open surgical treatment for spinal pneumatosis and achieved favorable prognostic outcomes.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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