Pneumorrhachis (PR) refers to free air in the spinal canal. We aim to describe a case report and conduct a systematic review focused on the clinical presentation, diagnosis, and management of traumatic PR. We conducted a language-restricted PubMed, SciELO, Scopus, and Ovid database search for traumatic PR cases published till June 2019. Categorical variables were assessed by Fisher's exact test. In addition to our reported index case, there were 82 articles (96 individual cases) eligible for meta-analysis according to our inclusion/exclusion criteria. Eighty per cent of patients had blunt trauma, while 17% had penetrating injuries. Thirty-four per cent of cases were extradural PR, 21% intradural PR, and unreported PR type in 43%. Nine per cent of patients presented with symptoms directly attributed to PR: sensory radiculopathy (2%), motor radiculopathy (1%), and myelopathy (6%). CT had a 100% sensitivity for diagnosing PR, MRI 60%, and plain radiograph 48%. Concurrent injuries reported include pneumocephalus (42%), pneumothorax (36%), spine fracture (27%), skull fracture (27%), pneumomediastinum (24%), and cerebrospinal fluid leak (14%). PR was managed conservatively in every case, with spontaneous resolution in 96% on follow-up (median = 10 days). Prophylactic antibiotics for meningitis were given in 13% PR cases, but there was no association with the incidence of meningitis (overall incidence: 3%; prophylaxis group (0%) vs non-prophylaxis group (4%) (p = 1)). Occasionally, traumatic PR may present with radiculopathy or myelopathy. Traumatic PR is almost always associated with further air distributions and/or underlying injuries. There is insufficient evidence to support the use of prophylactic antibiotic in preventing meningitis in traumatic PR patients.

中文翻译：

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创伤性肺出血：系统评价和例举病例。

肺出血（PR）是指椎管内的自由空气。我们旨在描述一个病例报告，并针对外伤性PR的临床表现，诊断和管理进行系统的回顾。我们进行了语言受限的PubMed，SciELO，Scopus和Ovid数据库搜索，直到2019年6月为止发布的创伤性PR病例。分类变量通过Fisher的精确检验进行了评估。根据我们的纳入/排除标准，除了我们报告的索引病例外，还有82篇文章（96例个体病例）符合荟萃分析要求。80％的患者有钝性创伤，而17％的患者有穿透性损伤。34％的病例为硬膜外PR，硬膜内PR为21％，未报告PR为43％。9％的患者表现出直接归因于PR的症状：感觉神经根病（2％），运动神经根病（1％）和脊髓病（6％）。CT诊断PR的敏感性为100％，MRI诊断为60％，X线平片诊断为48％。报告的并发伤害包括气脑袋（42％），气胸（36％），脊柱骨折（27％），颅骨骨折（27％），肺动脉纵隔（24％）和脑脊液漏（14％）。在每种情况下，PR均保守治疗，随访时自发解决率达96％（中位数= 10天）。在13％的PR病例中使用了预防性脑膜炎的抗生素，但与脑膜炎的发生率无关（总发生率：3％；预防组（0％）与非预防组（4％）（p = 1）） 。有时，外伤性PR可能伴有神经根病或脊髓病。创伤性PR几乎总是伴随着更多的空气分布和/或潜在的伤害。