Definition

Spinal vascular malformations are abnormal connections between arteries and veins in the spinal column. Because the small blood vessels or capillaries that ordinarily lay between the arteries and veins are missing, blood does not flow normally. An increase in the pressure within the veins that drain off the spinal cord and a decreased ability of these veins to clear blood from the area can result in a loss of spinal cord function or hemorrhage (bleeding) into the spinal cord or the liquid surrounding the spinal cord. Spinal vascular malformations may involve the vertebral bodies, the spinal cord, the tissues surrounding the cord, or a combination of these locations.

These disorders include spinal arteriovenous malformations (AVMs), dural arteriovenous fistulas (DAVF), spinal hemangiomas, cavernous angiomas, cavernous malformations and aneurysms.


Spinal AVM

Causes

  • Congenital abnormalities of blood vessels occur in younger patient population
  • Subarachnoid hemorrhage
  • Increased venous pressure
  • Trauma may instigate spinal DAVF in older population

Risk Factors

There are no known risk factors associated the formation of spinal vascular malformations.

If AVMs go untreated, 50% of patients with gradual symptoms will be unable to walk within three years of onset. Results include:

  • Progressive damage to the spinal cord
  • Sudden hemorrhage with rapid neurological deterioration

Symptoms

Symptoms can occur acutely, or may take years to develop.

  • Sensory loss or abnormal sensations such as numbness or tingling
  • Back and leg pain
  • Upper or lower extremity weakness, depending on the location of the lesion
  • Disturbances of bladder and bowel function
  • Progressive neurological deficits
  • Paralysis
  • Sudden onset of severe back or neck pain and/or headache
  • Neck stiffness
  • Intolerance of bright light

Diagnosis

  • MRI
  • Myelography
  • Spinal angiography

Treatment

Generally, the lesions are treated with a combination of endovascular embolization and microsurgery, depending on the location and type of the arterial supply.  With prompt diagnosis and treatment, neurological dysfunction can be halted, and possibly even reversed.

Case Study

A 15 year old boy presented to an outside hospital with a two week history of pain between the shoulder blades and a sharp, shooting pain radiating down the right arm. He also noted decreased sensation from his torso to the feet, especially on his left side. A MRI showed a lesion at the T1 level and he had a laminectomy (removal of the bone covering the lesion) and biopsy. A spinal angiogram after the surgery showed a spinal arteriovenous malformation (AVM).
He continued to have left arm and trunk tingling. He was followed with serial MRIs for eight months when he came to Mount Sinai for a second opinion. He underwent spinal angiography with Dr. Aman Patel and it was decided that surgery was the best option to completely obliterate the AVM. Dr. Joshua Bederson performed the surgery. He did well post-operatively and a follow up angiogram did not show any residual filling. As his symptoms resolved he was gradually able to resume his normal activities, including basketball.

Disclaimer

Content generated and provided by Joshua B. Bederson, MD, Professor and Chairman of the Department of Neurosurgery at The Mount Sinai Health System.  Some of the information contained in this article was adapted from the National Institutes of Health.  Last reviewed June 2011 by the Department of Neurosurgery at The Mount Sinai Health System.

If you want to learn more about treatments for spinal vascular malformations that Mount Sinai has to offer, call the Mount Sinai Department of Neurosurgery at 212-241-2377.

Image courtesy of Dr. Joshua Bederson and Dr. Aman Patel