Acquired spinal dural arteriovenous fistula after lumbar surgery associated with lumbar disc herniation: a case report and literature review
Rao Hongming, Liang Guiqing, Liu Boling, Liu Shaoqiang, Lin Yuhan, Wang Huafeng, Chen Qiyong
Department of Spine Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, the Third Clinical Medical College, Fujian Medical University, Fuzhou 350007, China
Abstract：Objective This study aimed to describe a rare case of acquired spinal dural arteriovenous fistula (SDAVF) after lumbar surgery associated with lumbar disc herniation and clinical manifestations. Imaging features and treatment measures of SDAVF patients with lumbar disc herniation and/or lumbar spinal stenosis after spinal surgery were discussed combined with the literature. Methods The clinical data of a 65-years-old male who had a history of lumbar discectomy 10 years ago was retrospectively analyzed. He was diagnosed with acquired SDAVF associated with lumbar disc herniation. Pieces of literature about SDAVF associated with lumbar disc herniation and/or spinal stenosis before January 2022 were searched in CNKI, Wanfang, Weipu, and PubMed database using "脊髓硬脊膜动静脉瘘", "脊髓硬脊膜动静脉畸形", "腰椎间盘突出", "腰椎管狭窄症", and "spinal dural arteriovenous fistula", "spinal dural arteriovenous malformation", "lumbar disc herniation", "spinal stenosis" as keywords. Nine English literature on nine cases were included. The clinical and imaging characteristics, mechanism of this disease, and treatment strategy of nine cases in the literature combined with this case were summarized. Results A 65-year-old male patient, with a history of L4/5 discectomy at an outside institution 10 years ago, suffered from sudden weakness of both lower limbs with sensory abnormalities after L2/3 discectomy and fenestration. Spinal angiography showed the formation of SDAVF supplied by the right L4 radicular artery, and the symptoms were significantly relieved after interventional embolization of the fistula. Results of follow-up for one and a half years were clinically cured. A total of 10 cases of acquired SDAVF with lumbar disc herniation and/or spinal stenosis were involved, including nine reported cases and a case in this paper. All patients were males, with ages ranging from 27-76(53.8±14.9) years old. Among them, nine patients had SDAVF in the previous surgical area and one in the nearby region. The clinical symptoms were progressive lower extremity weakness, sensory disturbance, and sphincter disturbance. In addition, the atypical symptoms, such as chronic low back pain, claudication, and saddle anesthesia were observed. MRI demonstrated swelling and increased T2-weighted signal in the spinal cord, enhanced MRI can find a "moth-eaten" flow void sign. Among them, three, four, and three patients underwent endovascular embolization, surgery, and embolization combined with surgery, respectively. After treatment, the clinical symptoms were relieved for all patients by various degrees. Conclusion SDAVF combined with lumbar disc herniation and/or lumbar spinal stenosis after spinal surgery is very rare in clinical practice. The clinical manifestations of patients are typical or atypical neurological dysfunction, with possible misdiagnosis or missed diagnosis. The imaging features of the disease are specific and can be used as the main basis for diagnosis. Early diagnosis and active intervention or surgical treatment to block the arteriovenous fistula are expected to maximize the recovery of the patient's neurological function.
饶宏明, 梁珪清, 刘伯龄, 刘少强, 林毓涵, 王华锋, 陈齐勇. 腰椎术后硬脊膜动静脉瘘合并腰椎间盘突出1例报道并文献复习[J]. 中华解剖与临床杂志, 2023, 28(5): 320-326.
Rao Hongming, Liang Guiqing, Liu Boling, Liu Shaoqiang, Lin Yuhan, Wang Huafeng, Chen Qiyong. Acquired spinal dural arteriovenous fistula after lumbar surgery associated with lumbar disc herniation: a case report and literature review. Chinese Journal of Anatomy and Clinics, 2023, 28(5): 320-326.
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2023, Vol. 28 
