Answer: Gas within an extended herniated disc.

Discussion
Elster and Jensen, in 1984, were the first to report gas within a symptomatic herniated disc in the cervical canal. They concluded that evidence of gas within the spinal canal strongly suggests a herniated disc with enclosed gas whether or not the disc has the characteristic density on computerized axial tomography. In separate studies, Mortensen et al. and Pierpaolo et al. reported on five patients who had gas within a herniated lumbar disc that was identified with high-resolution computerized axial tomography and was confirmed at operation.

Gas within the spinal canal rarely is found in a patient who has an injury of the cervical spinal cord. When it is seen, the surgeon should have a high level of suspicion of an extruded herniated disc and therefore should consider magnetic resonance imaging for additional clarification of the pathoanatomy.

Abraham, D.J.; Vaccaro, A.R.; Albert, T.J.; and Colter, J.M.: Gas in the spinal canal associated with injury of the cervical spinal cord: a diagnostic dilemma. A case report. J. Bone and Joint Surg., 79-A: 591-3, April 1997.

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