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Spinal Alignment and Cerebrospinal Fluid Accumulation Patterns in Spontaneous Intracranial Hypotension
Toshihide Takahashi1, Kiyoyuki Yanaka1, Hitoshi Aiyama1
1Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan.
Asian Journal of Neurosurgery
|July 31, 2026
Summary
Reduced cervical lordosis, or a straight neck, is linked to cerebrospinal fluid (CSF) accumulation patterns in spontaneous intracranial hypotension (SIH). This spinal alignment may contribute to SIH pathophysiology by influencing CSF retention.
Area of Science:
- Neurosurgery
- Radiology
- Spinal Anatomy
Background:
- Spontaneous intracranial hypotension (SIH) typically results from cerebrospinal fluid (CSF) leakage and subsequent epidural CSF accumulation.
- Traditional causes like bony spurs and disc degeneration don't fully explain SIH in younger individuals.
- This suggests other anatomical or biomechanical factors, such as cervical spinal alignment, may play a role.
Purpose of the Study:
- To investigate the hypothesis that cervical spinal alignment, specifically reduced lordosis, influences CSF retention patterns in SIH.
- To explore the potential contribution of spinal alignment to SIH pathophysiology.
Main Methods:
- Retrospective analysis of 30 SIH patients and 30 matched healthy controls.
- Measurement of cervical Cobb angles from lateral MRI scans.
- Evaluation of CSF accumulation (thickness, distribution, spinal level) and correlation with Cobb angles.
Main Results:
- SIH patients exhibited significantly smaller Cobb angles (reduced lordosis/straight neck) compared to controls (p=0.011).
- A strong association was observed between smaller Cobb angles and dorsal CSF accumulation (p<0.001).
- Ventral CSF retention was more common in the lower cervical spine, while dorsal retention was prevalent in the mid-thoracic region.
Conclusions:
- Reduced cervical lordosis is associated with specific CSF retention patterns in SIH, particularly dorsal accumulation.
- These findings highlight the clinical relevance of assessing spinal alignment in SIH patients.
- Further research is warranted to explore alignment-based interventions for mitigating dural stress and reducing CSF leakage risk.
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