Spinal Arteriovenous Malformations (AVMs) and Arteriovenous Fistulas (AVFs)

Spinal arteriovenous malformations (AVMs) and arteriovenous fistulas (AVFs) are rare vascular disorders that affect the spinal cord. In both conditions, abnormal connections form between arteries and veins, disrupting normal blood flow to the spinal cord and surrounding tissues. Over time, this can lead to reduced oxygen supply, deterioration of spinal cord function, and permanent neurological damage if left untreated.

Symptoms

Symptoms may develop gradually or occur suddenly and can include:

• Difficulty walking or impaired mobility
• Tingling or numbness in the legs
• Weakness in the legs or other parts of the body
• Lower back pain
• Headaches
• Neck stiffness
• Difficulty with bowel or bladder function

Diagnosis and Treatment Options

Diagnosis of spinal AVMs and AVFs typically involves:

• A thorough review of medical history, including signs and symptoms
• Physical and neurological examination
• Diagnostic imaging, such as X-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI)
• Spinal angiography to identify the location and structure of the abnormal blood vessels

Treatment depends on the size, location, and complexity of the AVM or AVF, as well as the severity of symptoms. Medications may be prescribed to manage symptoms or reduce the risk of complications. In some cases, surgery or other interventional procedures may be recommended.

Advances in microsurgical and endovascular techniques have made many previously difficult-to-treat lesions more accessible and safer to manage. Following successful treatment, AVMs and AVFs are unlikely to recur, and the risk of complications is generally low.

Current Surgical Procedures

• Embolisation Embolisation is a minimally invasive procedure in which a catheter is inserted through an artery in the groin and guided to the abnormal blood vessels using X-ray imaging. An embolic agent, often referred to as a medical “glue”, is injected to block the abnormal blood vessels and reduce or eliminate blood flow through the AVM or AVF.

• Radiosurgery Radiosurgery may be considered when the AVM or AVF cannot be safely removed surgically. This treatment uses precisely targeted radiation to damage the abnormal blood vessels, causing them to gradually scar, close, and stop carrying blood. There is no surgical incision, and the treatment effect typically develops over one to three years.

• Microsurgical Removal Surgical removal of an AVM or AVF may be recommended if there is bleeding, progressive neurological deterioration, or if the lesion can be safely accessed. Using a high-powered operating microscope, the surgeon isolates and seals the abnormal blood vessels before removing or disconnecting them from the surrounding spinal tissue.

Recovery from Surgery

Following surgery, your back may feel stiff or sore for a period of time, and you may find it uncomfortable to sit or remain in one position for extended periods. Activities such as lifting, bending, and twisting may be restricted during the early stages of recovery. Pain medication is commonly prescribed to assist with post-operative discomfort.

Recovery varies depending on the individual patient, the location of the AVM or AVF, and the type of treatment performed. As a general guide, recovery may include:

• A hospital stay of approximately five to seven days
• Avoidance of heavy lifting during the initial recovery period, with gradual progression of activity as advised
• Time away from work to allow for healing and recovery
• A temporary return to work on modified or restricted duties, if required
• Restrictions on driving for approximately four to six weeks, depending on recovery progress and medical advice
• Avoidance of swimming for four to six weeks
• Physiotherapy and rehabilitation, as required
• Ongoing pain management, if necessary
• Use of a back brace in some cases
• Assessment and support from an Occupational Therapist, if required

Dr Tollesson will provide specific recovery recommendations based on your individual condition, treatment, and recovery progress.