Cervical bone spur presenting with spontaneous intracranial hypotension. Case report

J Neurosurg. 1998 Sep;89(3):483-4. doi: 10.3171/jns.1998.89.3.0483.


Spontaneous intracranial hypotension due to a spinal cerebrospinal fluid (CSF) leak is a rare but increasingly recognized cause of postural headaches. The exact cause of these CSF leaks often remains unknown. The authors treated a 32-year-old man with a unique cause of spontaneous intracranial hypotension. He suffered an excruciating headache that was exacerbated by his being in an upright position. The results of four-vessel cerebral angiography were negative; however, magnetic resonance (MR) imaging of the brain revealed pachymeningeal enhancement and hindbrain herniation. A presumptive diagnosis of spontaneous intracranial hypotension was made. Myelography revealed extrathecal contrast material ventral to the cervical spinal cord as well as an unusual midline bone spur at C5-6. The patient's symptoms did not resolve with the application of epidural blood patches, and he subsequently underwent an anterior approach to the C5-6 spur. After discectomy, a slender bone spur that had pierced the thecal sac was found. After its removal, the dural rent was closed using two interrupted prolene sutures. The patient was discharged home 2 days later. On follow up his symptoms had resolved, and on MR imaging the pachymeningeal enhancement had resolved and the cerebellar herniation had improved slightly.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Blood Patch, Epidural
  • Cerebral Angiography
  • Cervical Vertebrae / pathology*
  • Cervical Vertebrae / surgery
  • Contrast Media
  • Diskectomy
  • Dura Mater / surgery
  • Encephalocele / etiology
  • Follow-Up Studies
  • Headache / etiology
  • Humans
  • Image Enhancement
  • Intracranial Hypotension / etiology*
  • Intracranial Hypotension / therapy
  • Magnetic Resonance Imaging
  • Male
  • Meninges / pathology
  • Myelography
  • Polypropylenes
  • Posture
  • Rhombencephalon / pathology
  • Spinal Osteophytosis / complications*
  • Spinal Osteophytosis / surgery
  • Suture Techniques
  • Sutures


  • Contrast Media
  • Polypropylenes