Volume 12 Supplement 1

Abstracts from Hydrocephalus 2015

Open Access

Cerebrospinal fluid dynamics at the lumbosacral level in patients with spinal stenosis

  • Keewon Kim1Email author,
  • Dong-Joo Kim2,
  • Kwang Dong Kim1,
  • Hack-Jin Lee2,
  • Chul-Ho Sohn1,
  • Sun-Gun Chung1,
  • Se-Woong Chun1 and
  • Ho NamKoong1
Fluids and Barriers of the CNS201512(Suppl 1):P24


Published: 18 September 2015


The hydrodynamics of the cerebrospinal fluid (CSF) is well-known to contribute to neurological disorders of the brain. However, little attention has been paid to the CSF dynamics in the lumbosacral spine. Meanwhile, the pathomechanism of neurogenic claudication, a characteristic symptom of spinal stenosis, has not been clearly elucidated. In this study, we suspected that spinal stenosis may be associated with altered CSF dynamics and compared CSF flow velocities at the lumbosacral spinal level between patients with spinal stenosis and healthy controls, at rest and at claudication.


Twelve subjects (4 patients with spinal stenosis and 8 healthy controls; 25-77 years old; 7 males) underwent phase-contrast magnetic resonance imaging (PC-MRI) to quantify CSF dynamics at the lumbosacral spinal level. Using PC-MRI, the CSF flow velocities were measured at the L2 and S1 levels. All of the subjects underwent PC-MRI at rest and after walking (to provoke neurogenic claudication in the patients).


The flow rate in the sacral spine (caudal peak flow: -0.25 ± 0.28 cm/s) was greatly attenuated compared to the flow in the lumbar spine (caudal peak flow: -0.93 ± 0.46 cm/s) in both patients and controls. The caudal peak flow was slower in patients (-0.65 ± 0.22 cm/s) than controls (-1.07 ± 0.49 cm/s). The difference between the L2 caudal peak flow 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 CSF flow after walking was barely detectable in patients (caudal peak flow: -0.09 ± 0.03 cm/s) compared with controls (caudal peak flow: -0.32 ± 0.26 cm/s). The severity of structural stenosis (area or AP diameter of the spinal canal) did not correlate with the flow velocities within the participants.


CSF dynamics in the lumbosacral spine were more attenuated in patients with spinal stenosis than healthy controls in a manner that was not proportionate to the structural stenoses. After walking, the CSF flow rate did not exhibit an appropriate increase in patients experiencing claudication, whereas the flow rate did increase appropriately in controls. Altered CSF dynamics may partially explain the pathophysiology of spinal stenosis.

Authors’ Affiliations

Seoul National University Hospital
Department of Brain and Cognitive Engineering, Korea University


  1. Lee SH, Yoon C, Chung SG, Kim HC, Kwak Y, Park HW, Kim K: Measurement of Shoulder Range of Motion in Patients with Adhesive Capsulitis Using a Kinect. PLoS One. 2015, 10 (6):Google Scholar
  2. Capsule Preservation Improves Short-term Outcome of Hydraulic Distension in Painful Stiff Shoulder. J Orthop Res. 2011Google Scholar
  3. Yi Y, Jeong WJ, Kim W, Kim K: Contralateral Reinnervation in Patients with Facial Nerve Palsy. Otology & Neurotology. 2014Google Scholar
  4. Neuronox versus BOTOX for spastic equinus gait in children with cerebral palsy: a randomized, double-blinded, controlled multicentre clinical trial. Dev Med Child Neurol. 2011, 53 (3): 239-44. 10.1111/j.1469-8749.2010.03830.x.Google Scholar
  5. Cho Y, Lee G, Aguinaldo J, Lee KJ, Kim K: Correlates of bone mineral density and sagittal spinal balance in the aged. Ann Rehabil Med. 2015, 39 (1):Google Scholar
  6. Cauda equina syndrome misdiagnosed as aggravated hydrocephalus: neurological complication of intrathecal colistin in post-surgical meningitis. Acta Neurochir (Wien). 2011, 153 (2): 425-7. 10.1007/s00701-010-0810-7. Epub 2010 Sep 26Google Scholar
  7. Yi Y, Kang HJ, Shin HY, Kim K: Progressive Myelopathy Mimicking Subacute Combined Degeneration after Intrathecal Chemotherapy. Journal of Child Neurology. 2014Google Scholar
  8. Choi YA, Kim K, PM R: Sciatic Neuropathy Caused by Focal Venous Engorgement Associated with Deep Vein Thrombosis: A Case Report. 2015Google Scholar
  9. Shim JS, Chung SG, Bang H, Lee HJ, Kim K, PM R: Ulnar Neuropathy After Extracorporeal Shockwave Therapy: A Case Report. 2015, 7 (6):Google Scholar
  10. Seo HG, Oh BM, Kim K, PM R: Robot-assisted gait training in a patient with hereditary spastic paraplegia. 2015, 7 (2): 210-3.Google Scholar
  11. A case of symptomatic cervical perineural (Tarlov) cyst: clinical manifestation and management. Skeletal Radiol. 2012Google Scholar
  12. Diagnosis and management of muscle pain. J Korean Med Assoc. 2013Google Scholar


© Kim et al. 2015

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