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Lumbar intradural space reduction during the Valsalva maneuver observed using cine MRI and MR myelography: a single-case experimental study

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Abstract

Background

Previous studies have shown that the Valsalva maneuver (VM) causes spinal canal object movements. We hypothesized that this occurs because of cerebrospinal fluid (CSF) flow generated from intradural space reduction. Previous studies using myelograms reported lumbar CSF space changes during inspiration. However, no similar studies have been conducted using modern MRI. Therefore, this study analyzed intradural space reduction during the VM using cine magnetic resonance imaging (MRI).

Methods

The participant was a 39-year-old, healthy, male volunteer. Cine MRI involved fast imaging employing steady-state acquisition cine sequence during three resting and VM sets for 60 s each. The axial plane was at the intervertebral disc and vertebral body levels between Th12 and S1 during cine MRI. This examination was performed on 3 separate days; hence, data from nine resting and VM sets were available. Additionally, two-dimensional myelography was performed during rest and the VM.

Results

Intradural space reduction was observed during the VM using cine MRI and myelography. The intradural space cross-sectional area during the VM (mean: 129.3 mm2; standard deviation [SD]: 27.4 mm2) was significantly lower than that during the resting period (mean: 169.8; SD: 24.8; Wilcoxon signed-rank test, P < 0.001). The reduction rate of the vertebral body level (mean: 26.7%; SD: 9.4%) was larger than that of the disc level (mean: 21.4%; SD: 9.5%; Wilcoxon rank sum test, P = 0.0014). Furthermore, the reduction was mainly observed on the ventral and bilateral intervertebral foramina sides at the vertebral body and intervertebral disc levels, respectively.

Conclusion

The intradural space was reduced during the VM, possibly because of venous dilatation. This phenomenon may be associated with CSF flow, intradural object movement, and nerve compression, potentially leading to back pain.

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Data availability

The data that support the findings of this study are available from the corresponding author, [R.Y.], upon reasonable request.

Abbreviations

VM:

Valsalva maneuver

CSF:

Cerebrospinal fluid

IVVP:

Intervertebral venous plexus

FIESTA:

Fast imaging employing steady-state acquisition

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Acknowledgements

The authors acknowledge Takashi Kanezawa, R.T. and Emiya Koike, R.T. for their technical assistance. We would like to thank Editage (www.editage.com) for English language editing.

Author information

Authors and Affiliations

  1. Department of Radiology and Nuclear Medicine, Fukushima Medical University School of Medicine, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan

    Ryo Yamakuni, Shiro Ishii, Tatsuya Ando, Kenji Fukushima & Hiroshi Ito

  2. Department of Radiology, Fukushima Medical University Hospital, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan

    Shinya Seino, Hironobu Ishikawa & Katsuyuki Kikori

  3. Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan

    Takeyasu Kakamu

  4. Department of Orthopedic Surgery, Fukushima Medical University School of Medicine, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan

    Koji Otani

Authors
  1. Ryo Yamakuni
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  2. Shinya Seino
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Contributions

Conceptualization: R.Y. Data curation: R.Y., T.A., S.S. Measurement of intradural space cross section: R.Y. MRI sequence check: H.I., K.K., S.S. Formal analysis: R.Y., T.K. Supervision: S.I., K.O., H.I. Methodology: K.F., H.I. Project administration: H.I. Writing—original draft: R.Y.

Writing—review and editing: R.Y., S.S., S.I., H.I., K.K., T.A., T.K., K.F., K.O., and H.I.

Corresponding author

Correspondence to Ryo Yamakuni.

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Ethics approval

The study was approved by the Research Ethics Committee of Fukushima Medical University (no. 2022–221). It was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments.

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Written informed consent was obtained from the participant.

Conflict of interest

The authors declare no competing interests.

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Yamakuni, R., Seino, S., Ishii, S. et al. Lumbar intradural space reduction during the Valsalva maneuver observed using cine MRI and MR myelography: a single-case experimental study. Acta Neurochir 165, 2111–2120 (2023). https://doi.org/10.1007/s00701-023-05678-4

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  • DOI: https://doi.org/10.1007/s00701-023-05678-4

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