Thoracolumbar Spinal Arteriovenous Fistula : A Case Report

Rizal Alexander Lisan, dr.* , Primadenny Ariesa Airlannga, dr., M.Si., Sp.OT(K)**

*PPDS 1 Program Studi Orthopaedi dan Traumatologi FK Universitas Airlangga/RSUD dr.

Soetomo Surabaya
**Staf Pengajar Program Sudi Orthopaedi Traumatologi FK Universitas Airlangga/RSUD dr.
Soetomo Surabaya

Introduction
A spinal arteriovenous fistula is an abnormally layered connection between radicular
arteries and venous plexus of the spinal cord. This vascular condition is relatively rare with
an incidence of 5 - 10 cases per million in the general population.

History of Current Illness

A – 10 year – old man presented with weakness of both legs suddenly during
activity 3 months ago. A week prior, he had low back pain and also experienced numbness
and tingling sensation on both legs. Neurological examination revealed anasthesia in the
Th11 bilaterally and decreased muscle strengths (0/5) in the lower extremities as well as
bladder and bowel dysfunction. Contrast-enchanced MRI and DSA demonstrated
arteriovenous fistula at the level VTh9 - VS1, which was supplied from sacral artery and also
varix at the level VTh9 which caused engorgement of perimedullary veins.

Discussion
Spinal cord and nerve root compression by extradural veins with varicose dilation
seems to cause the radiculopathy and / or myelopathy, and subsequent myelopathy caused by
spinal venous hypertension is believed to be the main etiology in this case. Diagnosis of
spinal arteriovenous fistula is differentiated by contrast-enhanced magnetic resonance
imaging and requires spinal angiography methods. Available treatment includes endovascular
embolization and microsurgical techniques.

Solution and Rationale

Endovascular embolization with N-butyl Cyanoacrylate were performed. Complete
angiographic obliteration of the fistula was successful. An angiogram at the end of the
procedure demonstrated resolution of the fistula and improvement in venous hypertension. A
post embolization MRI demonstrated expected improvement in spinal cord edema as well as
decreased abnormal spinal vascular engorgement. Two months after embolization, the AVF
was surgically removed

Final Outcome
Patient had shown improvement in strength of both lower extremities, and
sensations as well as improvement over bladder and anal control. He is capable of getting up
from lying position without assistance . He is presently undergoing physiotherapy for
rehabilitation of the extremity weakness.

Keywords : arteriovenous fistula, arteriovenous malformation, embolization