Takeaway
Lateral decubitus digital subtraction myelogram (LDDSM) shows a high diagnostic yield for pinpointing the exact location of spinal cerebrospinal fluid (CSF) leak in patients, which increases with higher Bern spontaneous intracerebral hypotension (SIH) score.
Why this matters
A number of imaging modalities such as LDDSM are used to aid diagnosis of SIH (due to CSF leak from thecal sac or along nerve root sleeve); however, data on this specific technique is limited due to the relative rarity of SIH and consequent lack of institutions utilizing it.
Association of higher SIH scores with greater likelihood of LDDSM-identified leaks may direct clinical practice by reducing the need for invasive procedures, potentially enhancing patient quality of life and emotional outcomes, as well as adherence to clinical treatment plans.