Cerebrospinal fluid dynamics correlate with neurogenic claudication in lumbar spinal stenosis

Abstract

Neurogenic claudication is a typical manifestation of lumbar spinal stenosis (LSS). However, its pathophysiology is still unclear. The severity of clinical symptoms has been shown not to correlate with the degree of structural stenosis. Altered cerebrospinal fluid (CSF) flow has been suggested as one of the causative factors of LSS. The objectives of this study were to compare CSF dynamics at the lumbosacral level between patients with LSS and healthy controls and to investigate whether CSF dynamics parameters explain symptom severity in LSS. Phase-contrast magnetic resonance imaging (PC-MRI) was conducted to measure CSF dynamics in 18 healthy controls and 9 patients with LSS. Cephalic peak, caudal peak, and peak-to-peak CSF velocities were evaluated at the lumbosacral level in the patients and controls. The power of CSF dynamics parameters to predict symptom severity was determined using a linear regression analysis adjusted for demographic and structural variables. Significantly attenuated CSF flow velocity was observed in the patients compared with the controls. The cephalic peak, caudal peak, and peak-to-peak velocities at the lumbar level were greater in the controls than in the patients (p<0.001). The predictive power increased most when the peak-to-peak velocity was added (adjusted R2 = 0.410) to the model with age, body mass index, and the minimum anterior-posterior diameter (adjusted R2 = 0.306), and the peak-to-peak velocity was the only statistically significant variable. CSF dynamics variables showed an association with the severity of LSS symptoms, independent of structural stenosis. PC-MRI can help to further our understanding of the pathophysiology of neurogenic claudication and support the diagnosis of LSS.

Characterising spinal cerebrospinal fluid flow in the pig with phase-contrast magnetic resonance imaging

“…Several studies have characterised normal CSF dynamics along the spine in healthy humans [22][23][24][25] and non-human primates (NHP) [26]. Other studies have found that obstructions to the intrathecal space may cause changes to CSF dynamics in the context of cervical myelopathy [27][28][29] and in neurogenic claudication in lumbar spinal stenosis [30].…”

Morphine Overdose After an Anterior Cervical Discectomy and Fusion in a Patient With an Intrathecal Morphine Pump

“…1 Cervical stenosis causes compression of the subarachnoid space and spinal cord, and disrupts normal cerebrospinal fluid (CSF) circulation which may be restored with surgical decompression. [2][3][4] Because IDDS rely on CSF flow for drug distribution, cervical stenosis may lead to caudal drug pooling with subsequent release and cephalad spread upon decompression. 5 We report a 63-year-old, 108 kg man with a history of obesity, obstructive sleep apnea, chronic obstructive pulmonary disease, urothelial carcinoma, and chronic back pain presenting for C3-C6 anterior cervical discectomy and fusion for severe spinal stenosis (Fig.…”

“…D’Souza et al1 recently demonstrated that patients with intrathecal drug delivery systems (IDDS) tolerate additional perioperative opioids; however, we urge caution in opioid administration for patients with IDDS undergoing decompression of cervical spinal stenosis 1. Cervical stenosis causes compression of the subarachnoid space and spinal cord, and disrupts normal cerebrospinal fluid (CSF) circulation which may be restored with surgical decompression 2–4. Because IDDS rely on CSF flow for drug distribution, cervical stenosis may lead to caudal drug pooling with subsequent release and cephalad spread upon decompression 5…”