Ultrafast dynamic computed tomography myelography for the precise identification of high-flow cerebrospinal fluid leaks caused by spiculated spinal osteophytes

J Neurosurg Spine. 2015 Mar;22(3):324-31. doi: 10.3171/2014.10.SPINE14209. Epub 2015 Jan 2.


Object: Precise localization and understanding of the origin of spontaneous high-flow spinal CSF leaks is required prior to targeted treatment. This study demonstrates the utility of ultrafast dynamic CT myelography for the precise localization of high-flow CSF leaks caused by spiculated spinal osteophytes.

Methods: This study reports a series of 14 patients with high-flow CSF leaks caused by spiculated spinal osteophytes who underwent ultrafast dynamic CT myelography between March 2009 and December 2010. There were 10 male and 4 female patients, with an average age of 49 years (range 37-74 years). The value of ultrafast dynamic CT myelography in depicting the CSF leak site was qualitatively assessed.

Results: In all 14 patients, ultrafast dynamic CT myelography was technically successful at precisely demonstrating the site of the CSF leak, the causative spiculated osteophyte piercing the dura, and the relationship of the implicated osteophyte to adjacent structures. Leak sites included 3 cervical, 11 thoracic, and 0 lumbar levels, with 86% of the leaks occurring from C-5 to T-7. Information obtained from the ultrafast dynamic CT myelogram was considered useful in all treated CSF leaks.

Conclusions: Spinal osteophytes piercing the dura are a more frequent cause of high-flow CSF leaks than previously recognized. Ultrafast dynamic CT myelography adds value beyond standard dynamic myelography or digital subtraction myelography in the diagnosis and anatomical characterization of high-flow spinal CSF leaks caused by these osteophytes. This information allows for appropriate planning for percutaneous or surgical treatment.

Keywords: DS = digital subtraction; cerebrospinal fluid leak; disc protrusion; headache; low pressure; osteophyte; technique.

MeSH terms

  • Adult
  • Aged
  • Cerebrospinal Fluid Leak / diagnosis*
  • Cerebrospinal Fluid Leak / etiology*
  • Cerebrospinal Fluid Leak / pathology
  • Dura Mater / pathology
  • Female
  • Humans
  • Intracranial Hypotension / diagnosis
  • Male
  • Middle Aged
  • Myelography* / methods
  • Osteophyte / complications*
  • Spinal Cord / pathology*
  • Tomography, X-Ray Computed / methods