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Relationship between lumbar spinal stenosis and cauda equina movement during the Valsalva maneuver

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Abstract

Objective

To confirm the relationship between lumbar spinal stenosis (LSS) and cauda equina movement during the Valsalva maneuver.

Materials and methods

Two radiologists at our institution independently evaluated cauda equina movement on pelvic cine MRI, which was performed for urethrorrhea after prostatectomy or pelvic prolapse in 105 patients (99 males; mean age: 69.0 [range: 50–78] years), who also underwent abdominopelvic CT within 2 years before or after the MRI. The qualitative assessment of the cine MRI involved subjective determination of the cauda equina movement type (non-movement, flutter, and inchworm-manner). The severity of LSS on abdominopelvic CT was quantified using our LSS scoring system and performed between L1/2 and L5/S1. We calculated the average LSS scores of two analysts and extracted the worst scores among all levels.

Results

Cauda equina movement was observed in 15 patients (14%), inchworm-manner in 10 patients, and flutter in five patients. Participants with cauda equina movement demonstrated significantly higher LSS scores than those without movement (P < 0.001, Wilcoxon’s rank-sum test). A significant difference was observed in the worst LSS scores between participants without movement and those with inchworm-manner movement (P < 0.001, Bonferroni’s corrected). There were no significant differences between participants without movement and those with flutter movement (P = 0.3156) and between participants with flutter movement and those with inchworm-manner movement (P = 0.4843).

Conclusion

Cauda equina movement in cine MRI during the Valsalva maneuver is occasionally observed in patients with severe LSS, and may be associated with pathogenesis of redundant nerve roots.

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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.

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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, Hirofumi Sekino, Kenji Fukushima & Hiroshi Ito

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

    Takeyasu Kakamu

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

    Hironobu Ishikawa & Shinya Seino

  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. Shiro Ishii
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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. 2021–243).

Informed consent

This cross-sectional retrospective study was approved by the institutional ethics committee. The requirement for written informed consent was waived due to data anonymization and retrospective nature of the study.

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The authors declare no competing interests.

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Supplementary Information

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Supplementary file1. A 69-year-old man with a history of prostatectomy. Cine MRI shows a flutter movement of the cauda equina during the Valsalva maneuver. The same image is shown in Figure 3a (MOV 534 KB)

Supplementary file2. A 65-year-old man with a history of prostatectomy. Cine MRI shows the movement of the cauda equina in an inchworm-manner during the Valsalva maneuver. The same image is shown in Figure 4a (MOV 880 KB)

Supplementary file3. A 61-year-old man with a history of prostatectomy. Cine MRI shows direct movement due to venous plexus dilation. The patient had no lumbar spinal stenosis. The same image is shown in Figure 5 (MOV 529 KB)

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Yamakuni, R., Ishii, S., Kakamu, T. et al. Relationship between lumbar spinal stenosis and cauda equina movement during the Valsalva maneuver. Skeletal Radiol 52, 1349–1358 (2023). https://doi.org/10.1007/s00256-022-04274-4

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  • DOI: https://doi.org/10.1007/s00256-022-04274-4

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