Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
World Neurosurg. 2019 Nov;131:e579-e585. doi: 10.1016/j.wneu.2019.08.010. Epub 2019 Aug 9.
Spinal arteriovenous malformations (AVM) are an abnormal interconnection of vasculature in the spine than can lead to significant neurologic deficit if left untreated.
The objective of this study was to characterize how patients with spinal AVM initially presented, what treatment options were used, and their overall outcomes on a national scale.
The MarketScan database was queried to identify adult patients diagnosed with a spinal AVM from 2007 to 2015. Trends in management, postoperative complication rates, and costs were determined.
In total, 976 patients were identified with having a diagnosis of a spinal AVM. Patients were more commonly treated with an open incision than an embolization (40.1% vs. 15.4%). The overall complication rate was 33.61%. Spinal AVM admissions have been stable over the past decade, and mean cost of hospitalization has risen from of $48,700 in 2007 to $71,292 in 2015. Patients who underwent open surgery had a greater complication rate than those treated with embolization (31.15% vs. 18.25%, P < 0.005); however, this may be strongly influenced by complexity of spinal AVM pathology and not treatment modality.
Costs of spinal AVM management continue to rise, even when treatment modalities have reduced length of stay significantly. Open surgery may lead to more postoperative complications and a greater length of stay than endovascular approaches. Further studies should look to identify the efficacy of endovascular approaches for spinal cord AVMs, particularly in complex spinal AVM traditionally treated with open surgery and to isolate factors leading to the elevated hospitalization costs.
脊柱动静脉畸形（AVM）是脊柱血管的异常连接，如果不治疗可能导致严重的神经功能缺损。
本研究旨在描述脊柱 AVM 患者的初始表现、使用的治疗选择以及他们在全国范围内的总体结果。
从 2007 年到 2015 年，市场扫描数据库被查询以确定被诊断为脊柱 AVM 的成年患者。确定了管理、术后并发症发生率和成本的趋势。
共确定了 976 例患有脊柱 AVM 诊断的患者。患者更常接受开放性切口治疗，而不是栓塞治疗（40.1%比 15.4%）。总体并发症发生率为 33.61%。过去十年，脊柱 AVM 入院人数保持稳定，住院费用从 2007 年的 48700 美元增加到 2015 年的 71292 美元。接受开放性手术的患者并发症发生率高于接受栓塞治疗的患者（31.15%比 18.25%，P<0.005）；然而，这可能主要受到脊柱 AVM 病理复杂性的影响，而不是治疗方式。
即使治疗方式大大缩短了住院时间，脊柱 AVM 管理的成本仍在继续上升。开放性手术可能导致更多的术后并发症和更长的住院时间，而血管内方法则不然。进一步的研究应该着眼于确定血管内方法治疗脊髓 AVM 的疗效，特别是在传统上采用开放性手术治疗的复杂脊柱 AVM 中，并分离导致住院费用升高的因素。
