Spinal Fistula and Spinal Arteriovenous Malformations

Our expert surgeons are experienced across a wide range of neurological and spinal issues, including spinal arteriovenous malformations (AVM) and spinal dural arteriovenous fistulas (dAVF). These abnormalities disrupt the normal flow of blood, nutrients, oxygen, and waste byproducts between tissues and can be life-threatening. At the onset of symptoms, patients should always seek immediate treatment. 

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What are spinal arteriovenous malformations and spinal dural arteriovenous fistulas? 

Spinal arteriovenous malformations (AVM) are rare tangles of blood vessels that form abnormal connections  between the arteries and veins on, in, or near the spinal cord. When the condition occurs specifically in the protective membrane covering the spinal cord (dura mater), it is called a spinal dural arteriovenous fistula (dAVF). 

Normally, capillaries, the smallest type of blood vessel, form a bridge between the arteries and veins and handle the transfer of nutrients and waste byproducts between blood and surrounding tissues. In an AVM or dAVF, the capillaries are missing, allowing blood to flow directly from the artery to the vein. Without the capillaries to slow the flow of blood, the increase in pressure can cause swelling and weaken the veins. . 

What are the symptoms of AVM or dAVF? 

Symptoms of AVM and dAVF in the spine can develop slowly and worsen over time., Many individuals may not experience any symptoms at all. Aggressive or advanced dAVFs can cause brain bleeding, otherwise known as a stroke. Delayed treatment  can lead to spinal cord damage and, eventually, paralysis. 

Physical symptoms can include: 

• Upper, mid, or low back pain
• Weakness
• Clumsiness
• Numbness
• The “pins and needles” sensation
• Loss of bladder/bowel control
• Sexual dysfunction

Neurological symptoms can include: 

• Problems walking
• Tremors, muscle stiffness, or difficulty in coordinating small hand movements

What is the difference between spinal AVM and spinal dAVF? 

While rare, spinal dural arteriovenous fistulas (dAVFs) comprise 70% of all spinal AVMs. They occur specifically around a spinal nerve root, typically around the upper portion of the spine. Patients with a spinal dAVF typically experience symptoms such as progressive weakness, numbness, pain, and difficulty walking as pressure increases in the spinal veins.

Aspinal arteriovenous malformation (AVM) is the condition in which an abnormal tangle of blood vessels develops in or around the spine. In a spinal AVM, blood flows directly from an artery to a vein without first running through the capillaries that deliver oxygen and nutrients from the blood to the surrounding tissues. This results in a decrease in oxygen and nutrients to the spine and an increased blood flow to the veins creates pressure that can cause the vein to rupture.  

Based on the malformation’s location, there are three primary types: intradural (occurring inside the protective layers surrounding the spinal cord), dural (in the outer covering of the spinal cord), or epidural (outside the dura of the spinal cord). 

How are AVMs and dAVFs treated? 

Left untreated, these abnormal connections can cause progressive spinal cord dysfunction and even paralysis. Our team of neurosurgeons works with you to determine the best and least invasive course of treatment for your individual case. In many cases, minimally invasive spine surgery is recommended, to help reduce pressure and restore the normal flow of blood.

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