Yang Baohui, Lu Teng, He Xijing, Li Haopeng
Department of Orthopedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Front Neurol. 2022 Sep 20;13:938342. doi: 10.3389/fneur.2022.938342. eCollection 2022.
Spinal dural arteriovenous fistula (SDAVF) is a rare disease that is often misdiagnosed by orthopedic surgeons. We analyzed the reasons for the misdiagnosis and proposed countermeasures.
Twenty-two SDAVF patients who were initially treated in orthopedics were included. The patients were divided into a correct diagnosis group (A) and a misdiagnosis group (B). The clinical data and prognosis were evaluated.
There were 10 patients in group A and 12 patients in group B. The clinical manifestations included limb numbness, weakness, and bladder and bowel dysfunction. Among these patients without spinal degenerative diseases which had typical magnetic resonance imaging (MRI) features in Group A were more than Group B ( < 0.05). More patients had spinal degenerative diseases in group B. In group A, seven patients were primarily diagnosed with a SDAVF after multidisciplinary teamwork (MDT). In group B, five patients were misdiagnosed with lumbar spinal stenosis, four with lumbar disc herniation, two with thoracic spinal stenosis, and one with cervical spinal stenosis and lumbar spinal stenosis and underwent cervical spinal canal and lumbar spinal canal decompression. The length of time for confirming the diagnosis was 7 months longer in group B than in group A. All patients underwent microsurgery treatment. The average follow-up duration was 11 months. The modified Aminoff-Logue Disability Scale scores showed a statistically significant difference in improvement between the two groups ( < 0.05).
when patients with dysuria especially, have intermittent spinal nerve dysfunction, the possibility of SDAVF should be considered. Awareness of the specific clinical and spinal cord edema and flow voids on MRI of a SDAVF needs to be promoted for orthopedic surgeons. Timely MDT is an important measure for reducing misdiagnosis, and steroids or inappropriate surgery should be avoided until a SDAVF is completely excluded.
脊髓硬脊膜动静脉瘘（SDAVF）是一种罕见疾病，常被骨科医生误诊。我们分析了误诊原因并提出应对措施。
纳入22例最初在骨科接受治疗的SDAVF患者。将患者分为正确诊断组（A组）和误诊组（B组）。评估临床资料和预后。
A组10例患者，B组12例患者。临床表现包括肢体麻木、无力以及膀胱和肠道功能障碍。在这些无脊髓退行性疾病的患者中，A组具有典型磁共振成像（MRI）特征的患者多于B组（<0.05）。B组有更多患者患有脊髓退行性疾病。在A组中，7例患者经多学科团队协作（MDT）后初步诊断为SDAVF。在B组中，5例患者被误诊为腰椎管狭窄，4例被误诊为腰椎间盘突出症，2例被误诊为胸椎管狭窄，1例被误诊为颈椎管狭窄和腰椎管狭窄，并接受了颈椎管和腰椎管减压术。B组确诊时间比A组长7个月。所有患者均接受了显微手术治疗。平均随访时间为11个月。改良的阿明诺夫 - 洛格残疾量表评分显示两组间改善情况有统计学显著差异（<0.05）。
尤其是排尿困难且伴有间歇性脊神经功能障碍的患者，应考虑SDAVF的可能性。需要提高骨科医生对SDAVF的特定临床表现以及MRI上脊髓水肿和流空现象的认识。及时的MDT是减少误诊的重要措施，在完全排除SDAVF之前应避免使用类固醇或进行不适当的手术。
