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

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.

Keywords: Cerebrospinal fluid; Cine magnetic resonance imaging; Magnetic resonance myelography; Two-dimensional single-slice magnetic resonance myelography; Valsalva maneuver; Vertebral venous system.