Penetrating Osseous Spicules Causing High-Flow Ventral CSF Leaks in the Setting of Relatively Low BMI: A Preliminary Study

Richard E. Rosebrock, Felix E. Diehn, Patrick H Luetmer, John T. Wald, John I. Lane, Jonathan M. Morris, Vance T Lehman, Carrie Carr, Bahram Mokri, Kent R. Thielen

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective/Background: We have anecdotally observed patients with high-flow ventral cerebrospinal fluid (CSF) leaks resulting from penetrating osseous spicules or calcified discs to be relatively thin. The purpose of this study was to explore the validity of this observation and determine if a potential association exists between low body mass index (BMI) and high-flow spinal ventral CSF leaks resulting from such dura-penetrating lesions. Methods: Sixteen consecutive patients with precisely localized high-flow ventral spinal CSF leaks on dynamic myelography were identified. The cause of the CSF leak was determined. The BMI on the date nearest to and within 2 weeks of myelography was recorded. Utilizing exact sign test, the body mass index was compared to the average BMI from the National Health and Nutrition Examination Survey (Centers for Disease Control), matched to sex and age-range. Results: The cohort consisted of 10 males (63%) and 6 females with a mean age of 54 years (range 37–72 years). In all patients, a spiculated osteophyte/calcified disc was identified at the site of the leak. Fourteen patients (88%) had a BMI below the matched national average, while only two patients (13%) had values above the national average (p = 0.004). Conclusions: Patients with high-flow ventral CSF leaks resulting from spiculated osteophyte or calcified disc as identified by dynamic myelography are more likely to have a BMI below the U.S. national average, matched for gender and age-range. This exploratory analysis requires confirmation as well as further characterization of potential pathophysiologic mechanisms and impact on radiographic and clinical assessments.

Original languageEnglish (US)
Pages (from-to)1-5
Number of pages5
JournalClinical Neuroradiology
DOIs
StateAccepted/In press - May 16 2017

Fingerprint

Body Mass Index
Myelography
Osteophyte
Nutrition Surveys
Centers for Disease Control and Prevention (U.S.)
Cerebrospinal Fluid Leak

Keywords

  • Body mass index
  • Low CSF pressure
  • Postural headache
  • Spiculated spinal osteophyte
  • Spontaneous intracranial hypotension (SIH)

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

Cite this

Penetrating Osseous Spicules Causing High-Flow Ventral CSF Leaks in the Setting of Relatively Low BMI : A Preliminary Study. / Rosebrock, Richard E.; Diehn, Felix E.; Luetmer, Patrick H; Wald, John T.; Lane, John I.; Morris, Jonathan M.; Lehman, Vance T; Carr, Carrie; Mokri, Bahram; Thielen, Kent R.

In: Clinical Neuroradiology, 16.05.2017, p. 1-5.

Research output: Contribution to journalArticle

Rosebrock, Richard E. ; Diehn, Felix E. ; Luetmer, Patrick H ; Wald, John T. ; Lane, John I. ; Morris, Jonathan M. ; Lehman, Vance T ; Carr, Carrie ; Mokri, Bahram ; Thielen, Kent R. / Penetrating Osseous Spicules Causing High-Flow Ventral CSF Leaks in the Setting of Relatively Low BMI : A Preliminary Study. In: Clinical Neuroradiology. 2017 ; pp. 1-5.
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abstract = "Objective/Background: We have anecdotally observed patients with high-flow ventral cerebrospinal fluid (CSF) leaks resulting from penetrating osseous spicules or calcified discs to be relatively thin. The purpose of this study was to explore the validity of this observation and determine if a potential association exists between low body mass index (BMI) and high-flow spinal ventral CSF leaks resulting from such dura-penetrating lesions. Methods: Sixteen consecutive patients with precisely localized high-flow ventral spinal CSF leaks on dynamic myelography were identified. The cause of the CSF leak was determined. The BMI on the date nearest to and within 2 weeks of myelography was recorded. Utilizing exact sign test, the body mass index was compared to the average BMI from the National Health and Nutrition Examination Survey (Centers for Disease Control), matched to sex and age-range. Results: The cohort consisted of 10 males (63{\%}) and 6 females with a mean age of 54 years (range 37–72 years). In all patients, a spiculated osteophyte/calcified disc was identified at the site of the leak. Fourteen patients (88{\%}) had a BMI below the matched national average, while only two patients (13{\%}) had values above the national average (p = 0.004). Conclusions: Patients with high-flow ventral CSF leaks resulting from spiculated osteophyte or calcified disc as identified by dynamic myelography are more likely to have a BMI below the U.S. national average, matched for gender and age-range. This exploratory analysis requires confirmation as well as further characterization of potential pathophysiologic mechanisms and impact on radiographic and clinical assessments.",
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T1 - Penetrating Osseous Spicules Causing High-Flow Ventral CSF Leaks in the Setting of Relatively Low BMI

T2 - A Preliminary Study

AU - Rosebrock, Richard E.

AU - Diehn, Felix E.

AU - Luetmer, Patrick H

AU - Wald, John T.

AU - Lane, John I.

AU - Morris, Jonathan M.

AU - Lehman, Vance T

AU - Carr, Carrie

AU - Mokri, Bahram

AU - Thielen, Kent R.

PY - 2017/5/16

Y1 - 2017/5/16

N2 - Objective/Background: We have anecdotally observed patients with high-flow ventral cerebrospinal fluid (CSF) leaks resulting from penetrating osseous spicules or calcified discs to be relatively thin. The purpose of this study was to explore the validity of this observation and determine if a potential association exists between low body mass index (BMI) and high-flow spinal ventral CSF leaks resulting from such dura-penetrating lesions. Methods: Sixteen consecutive patients with precisely localized high-flow ventral spinal CSF leaks on dynamic myelography were identified. The cause of the CSF leak was determined. The BMI on the date nearest to and within 2 weeks of myelography was recorded. Utilizing exact sign test, the body mass index was compared to the average BMI from the National Health and Nutrition Examination Survey (Centers for Disease Control), matched to sex and age-range. Results: The cohort consisted of 10 males (63%) and 6 females with a mean age of 54 years (range 37–72 years). In all patients, a spiculated osteophyte/calcified disc was identified at the site of the leak. Fourteen patients (88%) had a BMI below the matched national average, while only two patients (13%) had values above the national average (p = 0.004). Conclusions: Patients with high-flow ventral CSF leaks resulting from spiculated osteophyte or calcified disc as identified by dynamic myelography are more likely to have a BMI below the U.S. national average, matched for gender and age-range. This exploratory analysis requires confirmation as well as further characterization of potential pathophysiologic mechanisms and impact on radiographic and clinical assessments.

AB - Objective/Background: We have anecdotally observed patients with high-flow ventral cerebrospinal fluid (CSF) leaks resulting from penetrating osseous spicules or calcified discs to be relatively thin. The purpose of this study was to explore the validity of this observation and determine if a potential association exists between low body mass index (BMI) and high-flow spinal ventral CSF leaks resulting from such dura-penetrating lesions. Methods: Sixteen consecutive patients with precisely localized high-flow ventral spinal CSF leaks on dynamic myelography were identified. The cause of the CSF leak was determined. The BMI on the date nearest to and within 2 weeks of myelography was recorded. Utilizing exact sign test, the body mass index was compared to the average BMI from the National Health and Nutrition Examination Survey (Centers for Disease Control), matched to sex and age-range. Results: The cohort consisted of 10 males (63%) and 6 females with a mean age of 54 years (range 37–72 years). In all patients, a spiculated osteophyte/calcified disc was identified at the site of the leak. Fourteen patients (88%) had a BMI below the matched national average, while only two patients (13%) had values above the national average (p = 0.004). Conclusions: Patients with high-flow ventral CSF leaks resulting from spiculated osteophyte or calcified disc as identified by dynamic myelography are more likely to have a BMI below the U.S. national average, matched for gender and age-range. This exploratory analysis requires confirmation as well as further characterization of potential pathophysiologic mechanisms and impact on radiographic and clinical assessments.

KW - Body mass index

KW - Low CSF pressure

KW - Postural headache

KW - Spiculated spinal osteophyte

KW - Spontaneous intracranial hypotension (SIH)

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