The Importance of Preoperative Spinal Evaluation in Elderly Patients Undergoing Lumboperitoneal Shunting for Normal Pressure Hydrocephalus: A Case Report

Background: Lumboperitoneal (LP) shunting is an effective and less invasive treatment for normal pressure hydrocephalus (NPH). However, degenerative spinal changes, such as lumbar spinal stenosis, which are common in elderly patients, can complicate lumbar puncture and increase the risk of neurological complications. We report a case in which LP shunt placement failed due to severe lumbar spinal stenosis, highlighting the need for careful preoperative assessment of the spine. Case Presentation: An 80-year-old man presented with gait disturbance and physical debilitation. Magnetic resonance imaging (MRI) revealed ventricular enlargement, and a cerebrospinal fluid tap test resulted in symptomatic improvement; therefore, LP shunting was planned. Because lumbar puncture was unsuccessful, a ventriculoperitoneal shunt was performed instead. Postoperatively, the patient developed lower extremity pain, and an MRI revealed spinal stenosis from L2 to L5. Minimally invasive lumbar decompression was subsequently performed, resulting in symptom improvement and independent ambulation. Conclusion: Although LP shunting is generally safe, spinal stenosis may obstruct cerebrospinal fluid flow and reduce its effectiveness. Preoperative MRI evaluation of the spine is essential to guide puncture strategy, anticipate technical difficulties, and minimize complications in elderly patients.