Prognostic value of clinical and radiological signs in the postoperative outcome of spinal dural arteriovenous fistula

Raja Nandini Muralidharan, Jay Mandrekar, Giuseppe Lanzino, John L. Atkinson, Alejandro A. Rabinstein

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

Study Design. Retrospective consecutive case series. Objective. To determine predictors of outcome in patients undergoing surgical treatment of spinal dural arteriovenous fi stula (SDAVF). Summary of Background Data. Most previous studies assessing postoperative outcome in patients with SDAVF have been limited due to small population size, lack of suffi cient information on presurgical variables, or short time of postoperative follow-up. Consequently, the most reliable predictors of functional outcome after treatment of SDAVF are not yet well established. Methods. Retrospective analysis of consecutive patients with SDAVF treated surgically between June 1985 and March 2008 in our institution. The Aminoff-Logue gait (G) and micturition (M) scores were used to stratify the degree of disability and the G + M score was used as the primary outcome measure. Demographics, clinical presentation, time to diagnosis, fi stula level, presurgical motor and sphincter impairment, and magnetic resonance imaging fi ndings were assessed as prognosticators for postoperative outcomes. Results. One hundred fi fty-three patients were analyzed. Mean follow-up was 31 ± 36.2 months. Most patients were improved (44%) or stable (34%) upon the last follow-up. Among preoperative variables, worsening weakness with exertion was associated with a better G + M score at the last follow-up ( P < 0.001) and presence of pinprick level was associated with a worse G + M score at the last follow-up ( P = 0.020). On multivariable analysis, worsening weakness with exertion was associated with better outcome at the last follow-up, and higher G score at presentation and higher G + M score at discharge were associated with worse outcome at the last follow-up. Magnetic resonance images obtained postoperatively for 104 patients (mean, 19.1 ± 22.5 mo) showed complete resolution or improvement of the presurgical T2 signal abnormalities in 83.6% of cases. Changes in postoperative magnetic resonance image and fi stula level did not correlate with functional outcomes. Conclusion. The degree of preoperative disability from SDAFV does not determine who will benefi t most from surgery and even patients with severe defi cits can improve after treatment. Patients with preoperative exertional claudication and without pinprick level on examination have greater chances of postsurgical improvement.

Original languageEnglish (US)
Pages (from-to)1188-1193
Number of pages6
JournalSpine
Volume38
Issue number14
DOIs
StatePublished - Jun 15 2013

Keywords

  • Magnetic resonance imaging
  • Prognosis
  • Spinal dural arteriovenous fi stula
  • Surgery

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

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