Lumbar Nerve Root Compression Caused by Lumbar Intraspinal Gas: Report of Three Cases

Study Design. Three cases of lumbar nerve root compression associated with intradiscal gas formation and its migration are reported. Objectives. To establish the pathogenic mechanism by which gas is formed in the spinal canal. Summary of Background Data. Few such cases have been reported of patients with clinical symptoms of lumbar radiculopathy resulting from gas in the spinal canal. Methods. Surgery with needle aspiration of the gas was performed in all cases. Results. The presence of the gas was detected in the extradural space in one patient and within the nerve sheath in two patients. After surgery, all patients recovered well, and there were no obvious remnant neurologic abnormalities. One year later, all patients were completely free of symptoms. Conclusions. Surgery with needle aspiration of the gas resulted in clinical improvement in all cases, confirming that intraspinal gas is an important cause of lumbar radiculopathy. The composition of the gas in one patient was analyzed by gas chromatography, which revealed an overwhelming preponderance of nitrogen. A relationship between a gas-containing pseudocyst in the spinal canal and a degenerated intervertebral disc was identified, a key finding for understanding the precise nature of this disorder. Intradiscal gas formation and its outward migration as a sequel of intervertebral disc degeneration also has been addressed in this report.