Gas accumulation in the spinal canal: a systematic review and a novel CT-based classification

Abstract Objectives This systematic review aims to further explore the relationship between image and clinical features of spinal gas accumulation, propose a novel clinical classification based on CT images and clinical outcomes of surgical treatment and provide insights for new therapeutic strategi...

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Main Authors: Xin Chen, Jingming Wang, Lei Wang, Xiaoduo Xu, Qinglei Gong, Weimin Huang
Format: Article
Language:English
Published: BMC 2025-05-01
Series:Journal of Orthopaedic Surgery and Research
Subjects:
Online Access:https://doi.org/10.1186/s13018-025-05895-w
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author Xin Chen
Jingming Wang
Lei Wang
Xiaoduo Xu
Qinglei Gong
Weimin Huang
author_facet Xin Chen
Jingming Wang
Lei Wang
Xiaoduo Xu
Qinglei Gong
Weimin Huang
author_sort Xin Chen
collection DOAJ
description Abstract Objectives This systematic review aims to further explore the relationship between image and clinical features of spinal gas accumulation, propose a novel clinical classification based on CT images and clinical outcomes of surgical treatment and provide insights for new therapeutic strategies. Materials and methods Studies with data on gas accumulation in the spinal were retrieved by searching PubMed, Embase, and Web of Science from inception to August 20, 2023, and screened following the PRISMA guidelines. Characteristic information, CT and MRI morphologic features, and surgical results of patients with gas accumulation in the spinal were reviewed, and patients were categorized according to preoperative CT findings. Results A total of 41 articles were retrieved from the works of literature, including 53 patients with complete data. Among them, there were 29 males (59.70%) and 24 females (40.30%), with an average age of 65.8 years. We identified four types of gas accumulation in the spinal: Pseudocyst as pure gas (TypeI) with 34 cases (64.1%), Air cyst as epidural gas with a thin wall (TypeII) with 7 cases (13.2%), Air-contained disc herniation as epidural gas with disc herniation (Type III) with 3 cases (5.7%), intradural type (Type IV) with 9 cases(17.0%). 25 patients with Type I underwent non-conservative treatment and mild adhesions were observed in three patients. Adhesions were observed in 5 of the 6 Type II patients treated operatively. No adhesion was observed in three Type III patients. Adhesion was observed in 4 of 9 Type IV patients. Conclusion Gas accumulation in the spinal canal is a common clinical disease, which can be identified by CT and MRI. The classification based on CT scans helps guide clinical treatment.
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spelling doaj-art-7b146c56b708450f82de1ec7a2440a6c2025-08-20T02:25:12ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2025-05-0120111010.1186/s13018-025-05895-wGas accumulation in the spinal canal: a systematic review and a novel CT-based classificationXin Chen0Jingming Wang1Lei Wang2Xiaoduo Xu3Qinglei Gong4Weimin Huang5Orthopedic Department, 960 Hospital of People’s Liberation ArmyOrthopedic Department, 960 Hospital of People’s Liberation ArmyOrthopedic Department, 960 Hospital of People’s Liberation ArmyOrthopedic Department, 960 Hospital of People’s Liberation ArmyRadiology Department, 960 Hospital of People’s Liberation ArmyOrthopedic Department, 960 Hospital of People’s Liberation ArmyAbstract Objectives This systematic review aims to further explore the relationship between image and clinical features of spinal gas accumulation, propose a novel clinical classification based on CT images and clinical outcomes of surgical treatment and provide insights for new therapeutic strategies. Materials and methods Studies with data on gas accumulation in the spinal were retrieved by searching PubMed, Embase, and Web of Science from inception to August 20, 2023, and screened following the PRISMA guidelines. Characteristic information, CT and MRI morphologic features, and surgical results of patients with gas accumulation in the spinal were reviewed, and patients were categorized according to preoperative CT findings. Results A total of 41 articles were retrieved from the works of literature, including 53 patients with complete data. Among them, there were 29 males (59.70%) and 24 females (40.30%), with an average age of 65.8 years. We identified four types of gas accumulation in the spinal: Pseudocyst as pure gas (TypeI) with 34 cases (64.1%), Air cyst as epidural gas with a thin wall (TypeII) with 7 cases (13.2%), Air-contained disc herniation as epidural gas with disc herniation (Type III) with 3 cases (5.7%), intradural type (Type IV) with 9 cases(17.0%). 25 patients with Type I underwent non-conservative treatment and mild adhesions were observed in three patients. Adhesions were observed in 5 of the 6 Type II patients treated operatively. No adhesion was observed in three Type III patients. Adhesion was observed in 4 of 9 Type IV patients. Conclusion Gas accumulation in the spinal canal is a common clinical disease, which can be identified by CT and MRI. The classification based on CT scans helps guide clinical treatment.https://doi.org/10.1186/s13018-025-05895-wGasCystPseudocystCTClassificationSpine
spellingShingle Xin Chen
Jingming Wang
Lei Wang
Xiaoduo Xu
Qinglei Gong
Weimin Huang
Gas accumulation in the spinal canal: a systematic review and a novel CT-based classification
Journal of Orthopaedic Surgery and Research
Gas
Cyst
Pseudocyst
CT
Classification
Spine
title Gas accumulation in the spinal canal: a systematic review and a novel CT-based classification
title_full Gas accumulation in the spinal canal: a systematic review and a novel CT-based classification
title_fullStr Gas accumulation in the spinal canal: a systematic review and a novel CT-based classification
title_full_unstemmed Gas accumulation in the spinal canal: a systematic review and a novel CT-based classification
title_short Gas accumulation in the spinal canal: a systematic review and a novel CT-based classification
title_sort gas accumulation in the spinal canal a systematic review and a novel ct based classification
topic Gas
Cyst
Pseudocyst
CT
Classification
Spine
url https://doi.org/10.1186/s13018-025-05895-w
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AT jingmingwang gasaccumulationinthespinalcanalasystematicreviewandanovelctbasedclassification
AT leiwang gasaccumulationinthespinalcanalasystematicreviewandanovelctbasedclassification
AT xiaoduoxu gasaccumulationinthespinalcanalasystematicreviewandanovelctbasedclassification
AT qingleigong gasaccumulationinthespinalcanalasystematicreviewandanovelctbasedclassification
AT weiminhuang gasaccumulationinthespinalcanalasystematicreviewandanovelctbasedclassification