{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:29:33Z","timestamp":1786494573778,"version":"build-2736575974"},"reference-count":19,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,8,10]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Although pneumorrhachis is usually considered a benign radiological finding, in the epidural setting it may act as a compressive lesion and mimic surgically urgent pathology. This report describes a case of acute paraplegia following thoracic epidural analgesia caused by epidural air and highlights diagnostic and systems-related pitfalls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 68-year-old man with chronic pelvic osteomyelitis developed sudden thoracic pain and rapidly progressive bilateral lower extremity paresis during a programmed bolus administration through a thoracic epidural catheter. Emergency MRI demonstrated a dorsal epidural collection at T11\u201312 with marked conus medullaris compression that was interpreted as a spinal epidural abscess. Urgent surgical decompression was undertaken. Surgical exploration revealed epidural air without purulence or inflammatory tissue. The patient\u2019s neurological function recovered rapidly after decompression. Root cause analysis identified residual air within the infusion cassette combined with deactivated air-in-line detection as the most plausible mechanism for inadvertent epidural air delivery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Epidural pneumorrhachis should be considered in patients with acute neurological deterioration after epidural analgesia. When MRI findings are equivocal, CT can rapidly confirm the presence of air. Strict air-priming protocols and active air detection safeguards are essential to prevent neuraxial air complications.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE26351\">https:\/\/thejns.org\/doi\/10.3171\/CASE26351<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case26351","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:01:10Z","timestamp":1786492870000},"source":"Crossref","is-referenced-by-count":0,"title":["Acute paraplegia following epidural analgesia: diagnostic pitfalls in distinguishing pneumorrhachis from surgical mass lesions. Illustrative case"],"prefix":"10.3171","volume":"12","author":[{"given":"Jon H\u00e5vard","family":"Sommernes","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Oslo University Hospital, Oslo"},{"name":"Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mona Kristiansen","family":"Beyer","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo"},{"name":"Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f8rund","family":"Asvall","sequence":"additional","affiliation":[{"name":"Division of Emergencies and Critical Care, Department of Anesthesia, Intensive Care Medicine and Operating Services, Section of Anesthesia and Intensive Care Medicine, The Radium Hospital, Oslo University Hospital, Oslo"},{"name":"Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jarle","family":"Sundseth","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Oslo University Hospital, Oslo"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"suppl 5","key":"bib1","series-title":"Eur Spine J","first-page":"636","article-title":"Pathogenesis, diagnosis and management of pneumorrhachis","volume":"15","author":"Oertel","year":"2006","unstructured":"Oertel MFKorinth MCReinges MHKrings TTerbeck SGilsbach JM.Pathogenesis, diagnosis and management of pneumorrhachis. Eur Spine J. 2006;15(suppl 5):636-643. doi:10.1007\/s00586-006-0160-6"},{"issue":"1","key":"bib2","series-title":"J Med Case Rep","first-page":"263","article-title":"Hemodynamic instability caused by pneumorrachis and pneumomediastinum following epidural analgesia: a case report","volume":"18","author":"Fountoulaki","year":"2024","unstructured":"Fountoulaki MKapetanakis EIKouna NPapagiannis NSidiropoulou T.Hemodynamic instability caused by pneumorrachis and pneumomediastinum following epidural analgesia: a case report. J Med Case Rep. 2024;18(1):263. doi:10.1186\/s13256-024-04588-y"},{"issue":"1","key":"bib3","series-title":"J Med Case Rep","first-page":"387","article-title":"Cardiac arrest associated with pneumorrhachis and pneumocephalus after epidural analgesia: two case reports","volume":"12","author":"Shin","year":"2018","unstructured":"Shin HChoi HJKim CLee IOh JKo BS.Cardiac arrest associated with pneumorrhachis and pneumocephalus after epidural analgesia: two case reports. 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Anaesthesia. 2003;58(3):292-293. doi:10.1046\/j.1365-2044.2003.306721.x"},{"issue":"1","key":"bib12","series-title":"Korean J Anesthesiol","first-page":"66","article-title":"Paraplegia following cervical epidural catheterization using loss of resistance technique with air: a case report","volume":"69","author":"Chae","year":"2016","unstructured":"Chae YJHan KRPark HBKim CNam SG.Paraplegia following cervical epidural catheterization using loss of resistance technique with air: a case report. Korean J Anesthesiol. 2016;69(1):66-70. doi:10.4097\/kjae.2016.69.1.66"},{"issue":"5","key":"bib13","series-title":"Anaesthesia","first-page":"402","article-title":"Extradural air as a cause of paraplegia following lumbar analgesia","volume":"48","author":"Nay","year":"1993","unstructured":"Nay PGMilaszkiewicz RJothilingam S.Extradural air as a cause of paraplegia following lumbar analgesia. 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