Spinal vascular malformations

We may not have heard much about spinal vascular malformation. This phenomenon occurs more frequently in men. When this phenomenon occurs, there will also be symptoms of low back pain. There are more and more medical studies on spinal vascular malformations, and the symptoms of spinal vascular malformations are also classified differently. Many people want to know more about this spinal vascular malformation. Let us learn about it through a detailed introduction below.

Spinal vascular malformations generally occur in men at a much higher rate than in women, and are generally common among middle-aged people. This disease is very common in the thoracic and lumbar regions, but this disease is not highly hereditary, so patients should actively seek treatment to avoid serious consequences.

1. Type I clinical manifestations: Spinal dural arteriovenous malformations are more common in males than in females, with a male-to-female ratio of 4:1. The average age of patients is 40 to 50 years old. The lesions are mostly located in the thoracic and lumbar regions, and there is no obvious family tendency. Demographic data show that spinal dural arteriovenous malformations may be acquired diseases, and these lesions may be related to traumatic factors.

Pain is the most common symptom of patients with spinal arteriovenous malformations. Pain in the thoracic and lumbar back or buttocks may be the main symptom. Sometimes patients may experience radicular pain. Aminoff and Logue reported that 42% of patients complained of pain as their main symptom, and 33% of patients had sensory impairment rather than pain. Some patients often had hyperesthesia in the dermatomal distribution area adjacent to the area of ​​reduced pinprick sensation, and had a loss of light touch and position sense.

One-third of patients with spinal dural arteriovenous malformations have symptoms of motor dysfunction. These patients usually have mixed signs of dysfunction of upper motor neurons and lower motor neurons related to the lumbar spinal cord. Atrophy of the gluteal and gastrocnemius muscles is often accompanied by hyperreflexia of the lower limbs. Physical labor, prolonged standing and various postures such as leaning over, stooping, stretching or flexing increase venous congestion and can aggravate the symptoms.

2. Clinical manifestations of types II and III Spinal vascular malformations occurring in the dura mater include types II, III, and IV, among which type II (glomerular vascular malformation) and type III (immature or extensive vascular malformation) are located in the spinal cord.

Intramedullary lesions account for 10% to 15% of all spinal vascular malformations. Compared with spinal dural arteriovenous malformations, intramedullary lesions have a similar gender distribution. Intramedullary lesions can also occur in young patients. Foreign studies have reported that 75% of patients with intramedullary lesions are under 40 years old, 46% of lesions occur in the cervical spinal cord, and 44% occur in the thoracic and lumbar spinal cord.

The clinical manifestations of patients with intramedullary AVMs are significantly different from those of dural AVMs. Patients with intramedullary AVMs often suffer from intramedullary and subarachnoid hemorrhage, which may be accompanied by or without acute neurological dysfunction. 76% of patients have had bleeding at some point, and 24% of patients have neurological dysfunction due to bleeding. Intramedullary hemorrhage seems to be more common in cervical spinal AVMs. Some patients show progressive weakness, sensory impairment, sphincter dysfunction and impotence, often with intramedullary hemorrhage. About 20% of patients with intramedullary AVMs may develop intramedullary aneurysms. These spinal aneurysms are often located in the main nourishing vessels supplying the intramedullary AVMs. Patients with lesions in the mid-thoracic segment have a worse prognosis than those with lesions in other parts of the body. This may be related to the small number of collateral vessels in this segment. Patients with lesions in the cervical segment have a better prognosis.

3. Type IV clinical manifestations Type IV lesions are rare. In the report of Barrow and colleagues, type IV lesions accounted for 17% of the spinal vascular malformations treated in this medical center.

Patients with type IV lesions are usually younger than those with type I lesions and often develop symptoms before the age of 40 years. In the study reported by Barrow's group, half of the arteriovenous malformations were type IVa lesions, while Mourier and colleagues noted that 63% of the patients had type IVc malformations. Most patients presented with progressive myelopathy with pain, weakness, sensory and sphincter dysfunction, or subarachnoid hemorrhage, with no difference in distribution between men and women.

The spinal cord dysfunction in these patients is similar to that of type I lesions. The vascular congestion is caused by increased intradural venous pressure. The compressive effect of type IVc lesions significantly affects the function of the spinal cord and nerve roots. Barrow speculates that some of these lesions may be acquired. There have been several reports of patients who had undergone intrathecal surgery and/or craniospinal trauma before the onset of symptoms, suggesting that in some patients, the disease is acquired, while in others it is congenital.

The above is an introduction to spinal vascular malformations. Now everyone should have some understanding of this disease. Patients with spinal vascular malformations should avoid foods with too much fat in their diet, eat more vegetables and soy products to supplement some of the necessary nutrients, and should also receive treatment in the early stages, which will be beneficial to recovery from the disease.