• D C Kieser, D T Cawley, C Tavolaro, T Cloche, Cecile Roscop, Louis Boissiere, I Obeid, V Pointillart, J M Vital, and O Gille.
• L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France. kieserdavid@gmail.com.
• Eur Spine J. 2018 Jan 1; 27 (1): 231-235.

IntroductionThe incidence of pneumocephalus and pneumorrhachis after spinal surgery is unknown, with a paucity of literature on this complication.Materials And MethodsWe present the first published case of delayed onset tension pneumocephalus and pneumorrhachis associated with spinal surgery.ResultsThis complication occurred from a cerebro-spinal fluid (CSF) leak after posterior instrumentation removal and was successfully treated with emergent wound debridement and the formation of a CSF fistula.ConclusionsThis case illustrates that delayed post-operative tension pneumocephalus and pneumorrhachis can occur after spinal surgery in a patient with a CSF leak. It also illustrates that pneumocephalus and pneumorrhachis can be easily diagnosed with cross-sectional CT imaging. Furthermore, in a patient with rapid deterioration emergent surgical debridement may be necessary. Lastly, if the dural tear cannot be identified intra-operatively, the formalization of a CSF fistula should be considered.

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