Department of Neurological Surgery, Loyola University Medical Center, Maywood, IL, USA.
Spine (Phila Pa 1976). 2009 Oct 1;34(21):E775-9. doi: 10.1097/BRS.0b013e3181ae4a52.
Case report and literature review.
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.
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.
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.
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.
Delayed neurologic deterioration after spinal surgery is uncommon. Epidural arteriovenous fistulas with secondary intradural drainage, which are rare, should be considered.
病例报告和文献回顾。
硬脊膜外动静脉瘘伴髓周静脉逆流较为罕见。我们报告了一例腰椎手术后出现迟发性进行性充血性脊髓病的患者。讨论了负责动静脉瘘的病理生理学和解剖学基础。
脊柱手术后出现迟发性神经功能恶化并不常见。硬脊膜外瘘罕见地可因硬膜外血肿、静脉扩张引起的占位效应，或罕见地因硬脊膜动静脉瘘而出现症状。我们报告了一例腰椎手术后出现迟发性进行性充血性脊髓病的患者，并讨论了导致瘘管的病理生理学和解剖学基础。
一位 68 岁男性，因单侧腰椎板切除术和融合术治疗椎间盘突出症 2 年后出现进行性下肢无力和感觉减退以及括约肌控制丧失而就诊。MRI 显示弥漫性新的脊髓水肿和硬脊膜内髓周扩张的血管。脊髓血管造影显示先前椎板切除术部位有硬脊膜外动静脉瘘，伴有硬脊膜内髓周静脉引流。瘘管通过手术成功治疗，患者经历了快速和逐渐的神经改善，在修复后 6 周内能够无需拐杖行走。
腰椎脊柱手术后出现迟发性神经功能恶化的原因较少。硬脊膜外瘘并不常见，很少出现症状，当出现症状时，通常是由于硬膜外血肿或扩张的硬膜外静脉引起的占位效应。硬脊膜外瘘很少导致硬脊膜动静脉瘘，这是最常见的自发性脊髓动静脉病变，引起充血性脊髓病，表现为下肢痉挛、感觉改变和括约肌控制丧失。
腰椎手术后出现迟发性神经功能恶化并不常见。应考虑罕见的伴有髓周内引流的硬脊膜外动静脉瘘。
