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

AVMs and AVFs are both rare, usually genetic, spinal cord disorders. In both cases abnormal networks of blood vessels form on the spinal cord, disrupting the blood flow to spinal tissue, causing deterioration and damage.

Symptoms

Symptoms can be gradual or appear suddenly. They can include experiencing mobility problems, tingling and numbness in the legs, body weakness, lower back pain, headaches and stiffness of the neck, difficulty with bowel and bladder functions.

Diagnosis and Treatment Options for AVMs and AVFs

• X-ray, CT, MRI, angiograph,
• Evaluation of medical history, including signs and symptoms
• Medication to prevent bleeding
• Possible surgery

Surgical advances are making previously inoperable areas more accessible and safer for surgical removal. AVMs and AVFs do not usually grow back and the risk of complications is low.

Current Surgical Procedures Include:

• Embolization is a minimally invasive procedure where a catheter is inserted through the groin, reaching the spine using x-ray imaging. The catheter is used to inject an embolizing ‘glue’ that blocks the arteries feeding the AVM/AVF, reducing its blood flow.

• Radiosurgery might be used to shrink the blood vessels if the AVM/AVF can’t be removed surgically. It uses radiation to target small AVMs/AVFs that have not caused bleeding. There is no incision and an x-ray beam of radiation beam is directed at the AVM to damage and scar the blood vessels, which then clot and close up over a period of one to three years.
  

• Surgery to remove the AVM/AVF might be recommended if there is bleeding and the AVM/AVF can be easily located. The surgeon will use a high-powered microscope to seal off the AVM/AVF and remove it from spinal tissue.
  

Recovery from Surgery

Your back will most likely feel stiff or sore for a period of time and you may find it hard to sit still for long periods. It might also be difficult to lift and bend without causing pain. Pain medication helps to relieve the pain.

Recovery differs between patients and surgeries. As a general guide recovery may include the following:

• Five to seven days in hospital
• No heavy lifting for the first few weeks or so (and graduated lifting restrictions thereafter)
• Some time off work in order to recover
• You may need to return to work on restricted duties for a period of time
• You may not be able to drive for 4 to 6 weeks
• No swimming for 4 to 6 weeks
• Physiotherapy
• Pain medication
• Rehabilitation depending on the surgery
• A back brace is sometimes required
• You may need to meet with an Occupational Therapist