Iovtchev Ivelin, Hiller Nurith, Ofran Yona, Schwartz Isabella, Cohen Jose, Rubin Stuart A, Meiner Zeev
Department of Physical Medicine and Rehabilitation, PO Box 24035, Hadassah Hebrew-University Medical Center, Jerusalem, Israel.
Department of Radiology, PO Box 24035, Hadassah Hebrew-University Medical Center, Jerusalem, Israel.
Spine J. 2015 Jun 1;15(6):e39-44. doi: 10.1016/j.spinee.2013.08.029. Epub 2013 Oct 2.
Spinal dural arteriovenous fistula (SDAVF) is a slow-flow extramedullary vascular lesion affecting primarily the lower thoracic and lumbar spine. The clinical sequela of these vascular changes is progressive myelopathy and severe lower-extremity weakness. Although surgical or embolic treatment of SDAVFs has improved significantly in the last years, the ambiguity of the symptoms may complicate and delay the diagnosis. The influence of the postponed diagnosis on the functional outcome of patients with SDAVF is unknown.
To describe a case series of patients with SDAVF that illustrates that delayed diagnosis leads to grave neurologic and functional prognosis.
A case series.
We present a series of seven patients, treated in a tertiary university rehabilitation center over 20 years. Clinical, radiologic, and functional outcomes were evaluated by retrospective chart review. Neurologic and functional evaluation at the end of rehabilitation was evaluated with the lower extremities motor score and the Aminoff-Logue scale, respectively.
All our patients were men with a mean age of 60.3±16 years (30-72 years), mean time until the diagnosis of SDAVF was 302.8±239 days (60-730 days), and mean overall length of stay in acute department and rehabilitation unit was 88.6±34 days (46-149 days). At the end of rehabilitation period, four patients remained at wheelchair level with an Aminoff-Logue scale grading of five whereas other functional scales showed also low levels of recovery.
Our series showed that the potential for functional ambulation was poor despite prolonged rehabilitation treatment in late diagnosis SDAVF. Awareness of the early symptoms of SDAVF and immediate intervention may help reduce impairment in such patients.
脊髓硬脊膜动静脉瘘（SDAVF）是一种主要影响下胸段和腰段脊柱的缓慢血流髓外血管病变。这些血管变化的临床后果是进行性脊髓病和严重的下肢无力。尽管近年来SDAVF的手术或栓塞治疗有了显著改善，但症状的模糊性可能会使诊断复杂化并延迟诊断。延迟诊断对SDAVF患者功能结局的影响尚不清楚。
描述一组SDAVF患者病例，以说明延迟诊断会导致严重的神经和功能预后。
病例系列。
我们呈现了在一所三级大学康复中心20年间治疗的7例患者。通过回顾性病历审查评估临床、放射学和功能结局。康复结束时的神经和功能评估分别采用下肢运动评分和阿明诺夫-洛格量表进行。
我们所有患者均为男性，平均年龄60.3±16岁（30 - 72岁），诊断SDAVF的平均时间为302.8±239天（60 - 730天），在急诊科和康复科的平均总住院时间为88.6±34天（46 - 149天）。在康复期结束时，4例患者仍需轮椅辅助，阿明诺夫-洛格量表评分为5级，而其他功能量表显示恢复水平也较低。
我们的系列研究表明，尽管对晚期诊断的SDAVF进行了长期康复治疗，但其功能行走的潜力仍较差。认识SDAVF的早期症状并立即进行干预可能有助于减少此类患者的损伤。
