When normal-pressure hydrocephalus (NPH) occurs alongside severe spondylosis of the spine, hindered cerebrospinal fluid (CSF) communication along the spinal canal becomes a key clinical constraint that directly determines which intervention is appropriate.
Severe spondylosis of the spine obstructs CSF communication within the spinal canal. This anatomical barrier makes lumbar-based CSF diversion approaches unsuitable in this setting, and the shunting strategy must be selected accordingly.
Management in this scenario involves a ventriculo-peritoneal (VP) shunting approach with a programmable-pressure valve — chosen precisely because the spinal anatomy precludes a lumbar route. The complete valve configuration and pressure parameters are specified in the full protocol.
DOI: 10.2176/nmc.st.2020-0292