CASE STUDY Spinal Fistula Before and After

Endovascular gluing of spinal fistula

Subject: A man in his 60s with long-term back pain. Primary care physician had diagnosed degenerative spinal issue and prescribed painkiller which had no effect.

Diagnosis: Patient changed physicians. New doctor ordered an MRI, which revealed a tangle of veins that resembled a spinal fistula. Spinal dural arteriovenous fistulae (SDAVF) are very rare and most often diagnosed in men over 40. By the time the patient was referred to endovascular neurosurgeon Erik Hauck, MD, PhD, he could barely walk. Symptoms included progressive myelopathy and hypersensitivity in both legs.

Treatment: Although surgery is the standard treatment for SDAVF, Dr. Hauck opted to perform endovascular glue embolization to occlude the fistula and normalize blood flow to the spinal cord. Only one report exists in the literature of similar operations, involving Christopher Ogilvy, MD, at Massachusetts General Hospital, who happened to be Dr. Hauck’s co-fellow in endovascular neurosurgery at State University of New York in Buffalo. Long-term outcomes in that study found no evidence of recurrence a year after gluing.

Outcome: A follow-up MRI performed two months later revealed no spinal swelling. The man was walking normally and his pain was gone.