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Spinal epidural arteriovenous fistula with late onset perimedullary venous hypertension after lumbar surgery: case report and discussion of the pathophysiology.
Spine (Phila Pa 1976). 2009 Oct 01; 34(21):E775-9.S

Abstract

STUDY DESIGN

Case report and literature review.

OBJECTIVE

Spinal epidural arteriovenous fistulas with secondary reflux into the perimedullary veins are rare. We report a patient who presented with delayed progressive congestive myelopathy after lumbar surgery. The pathophysiology and the anatomic basis for the responsible arteriovenous fistula are discussed.

SUMMARY OF BACKGROUND DATA

Delayed neurological deterioration after spinal surgery is uncommon. Epidural fistulae uncommonly may become symptomatic from an epidural hematoma, mass effect from distended veins, and rarely from a spinal dural arteriovenous fistula. We report on a patient with delayed progressive congestive myelopathy after lumbar surgery, and discuss the pathophysiology and the anatomical basis for the causative fistula.

METHODS

A 68-year-old man presented with progressive lower extremity weakness and sensory decrease, and loss of sphincter control 2 years after unilateral lumbar laminectomy and fusion for a disc herniation. MRI showed diffuse new cord edema and intradural perimedullary dilated vessels. Spinal angiography revealed an epidural arteriovenous fistula at the site of the previous laminectomy, with intradural perimedullary venous drainage. The fistula was successfully treated surgically and the patient experienced rapid and gradual neurologic improvement, being able to walk without a cane within 6 weeks of repair.

RESULTS

There are few causes of delayed neurologic deterioration after lumbar spinal surgery. Epidural fistulas are uncommon and rarely symptomatic, and when they are, it is usually from an epidural hematoma or mass effect from distended epidural veins. Epidural may rarely result in spinal dural arteriovenous fistulas, the most common spontaneous spinal arteriovenous condition, causing a congestive myelopathy characterized by lower extremity spasticity, sensory changes, and loss of sphincter control.

CONCLUSION

Delayed neurologic deterioration after spinal surgery is uncommon. Epidural arteriovenous fistulas with secondary intradural drainage, which are rare, should be considered.

Authors+Show Affiliations

Department of Neurological Surgery, Loyola University Medical Center, Maywood, IL, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

19934798

Citation

Khaldi, Ahmad, et al. "Spinal Epidural Arteriovenous Fistula With Late Onset Perimedullary Venous Hypertension After Lumbar Surgery: Case Report and Discussion of the Pathophysiology." Spine, vol. 34, no. 21, 2009, pp. E775-9.
Khaldi A, Hacein-Bey L, Origitano TC. Spinal epidural arteriovenous fistula with late onset perimedullary venous hypertension after lumbar surgery: case report and discussion of the pathophysiology. Spine (Phila Pa 1976). 2009;34(21):E775-9.
Khaldi, A., Hacein-Bey, L., & Origitano, T. C. (2009). Spinal epidural arteriovenous fistula with late onset perimedullary venous hypertension after lumbar surgery: case report and discussion of the pathophysiology. Spine, 34(21), E775-9. https://doi.org/10.1097/BRS.0b013e3181ae4a52
Khaldi A, Hacein-Bey L, Origitano TC. Spinal Epidural Arteriovenous Fistula With Late Onset Perimedullary Venous Hypertension After Lumbar Surgery: Case Report and Discussion of the Pathophysiology. Spine (Phila Pa 1976). 2009 Oct 1;34(21):E775-9. PubMed PMID: 19934798.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Spinal epidural arteriovenous fistula with late onset perimedullary venous hypertension after lumbar surgery: case report and discussion of the pathophysiology. AU - Khaldi,Ahmad, AU - Hacein-Bey,Lotfi, AU - Origitano,Thomas C, PY - 2009/11/26/entrez PY - 2009/11/26/pubmed PY - 2010/1/6/medline SP - E775 EP - 9 JF - Spine JO - Spine (Phila Pa 1976) VL - 34 IS - 21 N2 - STUDY DESIGN: Case report and literature review. OBJECTIVE: Spinal epidural arteriovenous fistulas with secondary reflux into the perimedullary veins are rare. We report a patient who presented with delayed progressive congestive myelopathy after lumbar surgery. The pathophysiology and the anatomic basis for the responsible arteriovenous fistula are discussed. SUMMARY OF BACKGROUND DATA: Delayed neurological deterioration after spinal surgery is uncommon. Epidural fistulae uncommonly may become symptomatic from an epidural hematoma, mass effect from distended veins, and rarely from a spinal dural arteriovenous fistula. We report on a patient with delayed progressive congestive myelopathy after lumbar surgery, and discuss the pathophysiology and the anatomical basis for the causative fistula. METHODS: A 68-year-old man presented with progressive lower extremity weakness and sensory decrease, and loss of sphincter control 2 years after unilateral lumbar laminectomy and fusion for a disc herniation. MRI showed diffuse new cord edema and intradural perimedullary dilated vessels. Spinal angiography revealed an epidural arteriovenous fistula at the site of the previous laminectomy, with intradural perimedullary venous drainage. The fistula was successfully treated surgically and the patient experienced rapid and gradual neurologic improvement, being able to walk without a cane within 6 weeks of repair. RESULTS: There are few causes of delayed neurologic deterioration after lumbar spinal surgery. Epidural fistulas are uncommon and rarely symptomatic, and when they are, it is usually from an epidural hematoma or mass effect from distended epidural veins. Epidural may rarely result in spinal dural arteriovenous fistulas, the most common spontaneous spinal arteriovenous condition, causing a congestive myelopathy characterized by lower extremity spasticity, sensory changes, and loss of sphincter control. CONCLUSION: Delayed neurologic deterioration after spinal surgery is uncommon. Epidural arteriovenous fistulas with secondary intradural drainage, which are rare, should be considered. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/19934798/Spinal_epidural_arteriovenous_fistula_with_late_onset_perimedullary_venous_hypertension_after_lumbar_surgery:_case_report_and_discussion_of_the_pathophysiology_ L2 - https://doi.org/10.1097/BRS.0b013e3181ae4a52 DB - PRIME DP - Unbound Medicine ER -