The rise and fall of Queckenstedt's test between 1916 and 1970, a milestone in spinal cord diagnostics and why it matters

Eur J Neurol, 2025 · DOI: 10.1111/ene.16556 · Published: January 1, 2025

Simple Explanation

The Queckenstedt's test, developed in 1916, aimed to detect spinal cerebrospinal fluid (CSF) space obstruction. It involved applying bilateral jugular vein compression during lumbar puncture and observing changes in lumbar CSF pressure. The test results would indicate normal CSF flow, incomplete spinal block, or complete spinal block. James B. Ayer provided proof of concept in 1922 by simultaneously measuring cisternal and lumbar CSF pressure, showing that cisternal pressure remained responsive even with spinal block. The test became a routine diagnostic procedure but declined with advances in spinal computed tomography and magnetic resonance imaging. Despite its decline, there's renewed interest in understanding CSF biomechanical properties using advanced recording and computational techniques alongside spinal imaging. Spine and spinal cord physicians should recognize Queckenstedt's test as a significant milestone providing a physiological understanding of spinal cord compression.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Level 4, Systematic Literature Review

Key Findings

1
Queckenstedt's test was widely adopted globally for diagnosing spinal canal obstruction, particularly spinal tumors.
2
The test had high positive predictive value for tumor detection via myelography and higher sensitivity than protein count, especially for cervicothoracic intradural extramedullary tumors and metastases.
3
Refinements to the test included dynamic head positioning and quantifiable jugular vein compression to improve sensitivity and reliability.

Research Summary

This systematic review traces the evolution of Queckenstedt's test, a routine diagnostic procedure for CSF space constriction. Clinical studies investigated its diagnostic accuracy against operative findings, post-mortem analyses, myelography, and protein count, confirming its sensitivity for revealing spinal block. Queckenstedt's test was widely used in Europe and the United States by pioneering neurologists and neurosurgeons in spinal cord injury research. It ran parallel to invasive spinal imaging but was eventually abandoned for non-invasive techniques like CT and MRI, which provided more detailed structural information. Despite being supplanted by modern imaging, the framework behind Queckenstedt's test remains relevant, especially for degenerative spinal canal stenosis. It may be combined with advanced neuroimaging and intraoperative CSF monitoring, highlighting its potential in understanding CSF dynamics.

Practical Implications

Diagnostic Tool Augmentation

Queckenstedt's test could complement non-invasive imaging by providing information about CSF pressure and flow dynamics, which anatomical MRI does not offer.

Intraoperative Monitoring

The test could be adapted for intraoperative monitoring to quantify the effects of surgical decompression and spinal cord perfusion.

Drug Delivery Confirmation

In clinical trials using intrathecal drug administration, Queckenstedt's test can help confirm unrestricted CSF flow, ensuring effective drug distribution.

Study Limitations

1
Invasiveness of the procedure
2
Limited sensitivity in certain cases (e.g., tumors at the cranio-cervical junction or lumbosacral cord)
3
Lack of precise localization information compared to imaging techniques

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