Cerebrospinal fluid dynamics at the lumbosacral level in patients with spinal stenosis: A pilot study.
Spinal stenosis is a common degenerative condition. However, how neurogenic claudication develops has not been clearly elucidated. Moreover, cerebrospinal fluid physiology at the lumbosacral level has not received adequate attention. This study was conducted to compare cerebrospinal fluid hydrodynamics at the lumbosacral spinal level between patients with spinal stenosis and healthy controls. Twelve subjects (four patients and eight healthy controls; 25-77 years old; seven males) underwent phase-contrast magnetic resonance imaging to quantify cerebrospinal fluid dynamics. The cerebrospinal fluid flow velocities were measured at the L2 and S1 levels. All subjects were evaluated at rest and after walking (to provoke neurogenic claudication in the patients). The caudal peak flow velocity in the sacral spine (-0.25 ± 0.28 cm/s) was attenuated compared to that in the lumbar spine (-0.93 ± 0.46 cm/s) in both patients and controls. The lumbar caudal peak flow velocity was slower in patients (-0.65 ± 0.22 cm/s) than controls (-1.07 ± 0.49 cm/s) and this difference became more pronounced after walking (-0.66 ± 0.37 cm/s in patients, -1.35 ± 0.52 cm/s in controls; p = 0.028). The sacral cerebrospinal fluid flow after walking was barely detectable in patients (caudal peak flow velocity: -0.09 ± 0.03 cm/s). Cerebrospinal fluid dynamics in the lumbosacral spine were more attenuated in patients with spinal stenosis than healthy controls. After walking, the patients experiencing claudication did not exhibit an increase in the cerebrospinal fluid flow rate as the controls did. Altered cerebrospinal fluid dynamics may partially explain the pathophysiology of spinal stenosis. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:104-112, 2017.
Department of Rehabilitation Medicine, Gyeongsang National University College of Medicine, Gyeongsangnam-do, South Korea.
Se-Woong
SW
Chun
Department of Brain and Cognitive Engineering, Korea University, Anam-dong, Seongbuk-gu, Seoul, 136-713, South Korea.
Hack-Jin
HJ
Lee
Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea.
Koong-Ho
KH
Nam
Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea.
Chul-Ho
CH
Sohn
Department of Rehabilitation Medicine, Seoul National University College of Medicine, Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
Kwang Dong
KD
Kim
Department of Brain and Cognitive Engineering, Korea University, Anam-dong, Seongbuk-gu, Seoul, 136-713, South Korea.
Eun-Jin
EJ
Jeong
Department of Rehabilitation Medicine, Seoul National University College of Medicine, Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
Sun G
SG
Chung
Department of Rehabilitation Medicine, Seoul National University College of Medicine, Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
Keewon
K
Kim
Department of Brain and Cognitive Engineering, Korea University, Anam-dong, Seongbuk-gu, Seoul, 136-713, South Korea.
Dong-Joo
DJ
Kim
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002555:Cerebrospinal Fluid / Q000502:physiology*; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D013130:Spinal Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016138:Walking / Q000502:physiology
cerebrospinal fluid; hydrodynamics; lumbar spinal stenosis; phase-contrast magnetic resonance imaging