Spinal Alignment and Cerebrospinal Fluid Accumulation Patterns in Spontaneous Intracranial Hypotension

Objective: Spontaneous intracranial hypotension (SIH) is commonly caused by cerebrospinal fluid (CSF) leakage, resulting in epidural CSF accumulation. Although bony spurs and disc degeneration are traditionally implicated, SIH frequently affects younger individuals, suggesting that additional anatomical or biomechanical factors may contribute. We hypothesized that cervical spinal alignment, particularly reduced lordosis, may influence CSF retention patterns and contribute to SIH pathophysiology. Materials and Methods: A retrospective analysis was conducted on 30 SIH patients and 30 age- and sex-matched healthy controls. Cervical Cobb angles were measured from lateral MRI images, and CSF accumulation was evaluated for thickness, distribution (ventral vs. dorsal), and spinal level. Correlations were assessed between these variables. Statistical Analysis: -value of < 0.05 was considered statistically significant. Results: < 0.001). Ventral retention was more common in the lower cervical spine, while dorsal retention predominated in the mid-thoracic region. No significant correlation was observed between Cobb angle and CSF thickness or patient age. Conclusion: Reduced cervical lordosis is associated with distinct CSF retention patterns in SIH, particularly dorsal accumulation. Despite the limited sample size due to the rarity of SIH, consistent and statistically significant trends were observed. These findings support the clinical relevance of assessing spinal alignment in SIH and suggest that anatomical factors may influence dural vulnerability. Further research should explore whether alignment-based interventions can mitigate dural stress and reduce CSF leakage risk.