''Vacuum'' phenomena may occur within peripheral joints or in the spin
e. These phenomena are related to the accumulation of gas, principally
nitrogen, under physiologic or pathologic circumstances. Within the s
pine, vacuums may occur within the intervertebral discs and are useful
indicators of intervertebral osteochondrosis, spondylosis deformans,
Schmorl's nodes, and limbus vertebrae. In addition, intraosseous vacuu
m may occur within the vertebral bodies usually related to osteonecros
is. Under physiologic conditions, naturally occurring peripheral vacuu
ms cannot exist in the presence of joint fluid. This is often an easy,
inexpensive, noninvasive means of excluding a joint effusion. In this
review, the appearance, clinical importance, pathogenesis, and pitfal
ls of spinal and extra-spinal vacuums are discussed.