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A spinal cord vascular malformation is a tangle or abnormal connection of blood vessels in or around the spinal cord that disrupts normal blood flow and can damage the cord over time or suddenly if it bleeds. These are rare but potentially serious conditions because they can lead to progressive weakness, numbness, walking problems, or sudden paralysis.​

1) What is this condition?

  • It is an abnormal cluster or shortcut between arteries and veins (often called an AVM or fistula) on, in, or around the spinal cord.​

  • Types include:

    • Spinal dural arteriovenous fistulas (AVFs) on the covering of the cord.

    • Spinal AVMs inside the cord itself.​

  • Symptoms can include back pain, leg weakness, numbness, tingling, trouble walking, and bladder or bowel problems; some people present suddenly after bleeding, others progress slowly.​

2) How serious is it?

  • Without treatment, many patients gradually worsen; more than 40–50% of untreated spinal cord AVMs end up wheelchair‑bound within a few years in older reports.​

  • Some lesions can bleed suddenly, causing abrupt back pain and rapid weakness or paralysis.​

  • Spinal dural AVFs, if missed, often lead to steadily worsening leg weakness, numbness, and bladder problems, but treatment can stop and sometimes reverse this.​

3) Non‑surgical treatments

  • Careful observation with periodic MRI and exams is sometimes used for small, minimally symptomatic lesions when treatment risks are high.​

  • Medications focus on symptom control (pain, spasticity, bladder issues) but do not remove the abnormal vessels.​

  • True “curative” treatment is usually procedural (endovascular or surgical), not purely medical.​

4) Types of surgery / procedures that may be necessary

  • Endovascular embolization: a catheter is threaded through blood vessels (often from the groin) into the abnormal vessels and filled with glue‑like or coil materials to block them.​

  • Microsurgical disconnection or removal: open surgery on the spine to clip, tie off, or remove the abnormal connection or tangle from the cord or its covering.​

  • Occasionally, stereotactic radiosurgery (focused radiation) is used in selected AVMs as an adjunct or alternative.​

5) Goals of surgery vs non‑surgical care

  • Non‑surgical goals:

    • Monitor low‑risk lesions closely and manage symptoms while avoiding procedural risks when the chance of progression or bleeding is judged low.​

  • Endovascular / surgical goals:

    • Shut down the abnormal high‑flow connection to relieve pressure on the cord’s veins, restore more normal blood supply, and prevent further damage or bleeding.​

    • Stabilize or improve walking, strength, sensation, and bladder/bowel function.​

6) How surgery can “fix” the problem

  • In spinal dural AVFs, surgery or embolization closes the small feeding vessel on the dura (covering), stopping high‑pressure blood from flooding the spinal veins and relieving chronic congestion.​

  • In spinal AVMs within the cord, embolization or microsurgery aims to remove or shut down the central “nidus” of tangled vessels, reducing the risk of bleeding and pressure on the cord.​

7) Risks of surgery (general and specific)

  • General risks: bleeding, infection, blood clots, anesthesia complications.​

  • Specific:

    • Worsening neurologic deficits if normal spinal cord blood supply is accidentally compromised during embolization or surgery.​

    • Incomplete closure of the malformation, with risk of recurrence or ongoing progression.​

8) Chances this surgery will work

  • For spinal dural AVFs, surgery closes the fistula in about 98% of cases on first attempt, with 89% of patients improved or stabilized neurologically in one large series.​

  • Embolization for dural AVFs can also be effective (initial complete closure around 80–90% in some series), but has higher recurrence and retreatment rates than surgery.​

  • For intramedullary AVMs, cure is more challenging; embolization and/or surgery can reduce risk and often improve or stabilize symptoms, but complete eradication is not always feasible.​

9) Possible complications from the surgery

  • New or worsened leg weakness, numbness, or bladder/bowel dysfunction if the cord is injured or key vessels are occluded.​

  • Recurrence of the malformation or development of new feeding vessels, especially after embolization alone, sometimes needing additional procedures.​

  • Rarely, bleeding or stroke‑like events during or shortly after the procedure.​

10) Typical recovery from the condition

  • Without treatment, many patients have slowly worsening gait, leg strength, and bladder control, especially with dural AVFs and some AVMs.​

  • After successful treatment, progression usually stops, and many patients experience partial improvement in walking and sensation over months, though complete return to normal may not occur.​

11) Typical recovery after surgery / embolization

  • Hospital stay is usually short (a few days) for isolated endovascular or microsurgical procedures, longer if deficits are severe.​

  • Neurologic improvement often unfolds slowly over 6–12 months, as swelling settles and the cord recovers from chronic congestion or prior small injuries.​

  • Physical and occupational therapy focus on strengthening, balance, walking, and bladder/bowel strategies as needed.​

12) How long in the hospital

  • Many patients undergoing embolization or limited surgery stay 2–5 days, depending on pre‑existing deficits and complications.​

  • Those with acute bleeding or severe paralysis may need longer hospitalization and subsequent inpatient rehabilitation.​

13) Long‑term outlook

  • For spinal dural AVFs treated successfully, roughly 80–90% of patients show improvement or stabilization at 1 year; pre‑treatment disability level is the strongest predictor of final outcome.​

  • Untreated spinal AVMs and AVFs often lead to significant disability; nearly half of patients in older series ended up bed‑ or wheelchair‑bound within a few years.​

  • Early diagnosis and treatment before severe deficits develop offer the best chance of maintaining independence.​

14) Need for outpatient follow‑up

  • Regular follow‑up with neurology/neurosurgery and endovascular specialists, including repeat MRI and often catheter angiography to confirm the lesion is fully closed and has not recurred.​

  • Ongoing rehab and symptom management (spasticity, pain, bladder issues) to maximize function and quality of life.​

  • Long‑term monitoring is important, as some lesions can reopen or new abnormal vessels may develop, requiring re‑evaluation if symptoms change.