At 8:00 a.m. on Monday morning, I came to the neurosurgery clinic as usual, and an old man in his 60s was waiting in my consultation room in a wheelchair. After inquiry, old Yan is a 62-year-old retired senior horticulturist, who has been suffering from the disease for almost 4 years, at first it was just numbness in both feet, but later it became numbness in both legs, with a feeling like ants crawling on the legs, and when he walked a little farther, he felt that his legs were as weak as lead, and he had to rest for a while before he could continue walking. He was diagnosed with lumbar disc herniation and lumbar spinal stenosis, and the doctor recommended that he have lumbar spinal decompression surgery, which went well after the surgery. The local doctor let him do a lumbar CT, the diagnosis is still lumbar spinal stenosis, but also continue the surgery decompression, so Lao Yan did a second lumbar spinal decompression surgery, and three months have passed, Lao Yan felt that the symptoms not only did not reduce, but heavier, clenched his teeth can only walk three, four hundred meters, urination and defecation is not working, dry stool difficulties, urine can not make the effort, also can not urinate clean, and sometimes even urinate pants. The doctor explained that the width and length of the first two surgeries were not enough to decompress the nerve, which is why the problem was aggravated and a third surgery was necessary. The doctor explained that the width and length of the first two surgeries were not wide enough to relieve the nerve compression, which is why it was aggravated and a third decompression surgery was necessary. Shandong Province Qianfo Mountain Hospital neurosurgery Meng Xiangjing understand these circumstances, I asked Lao Yan, the first few times to see what department, Lao Yan said, “three hospitals to see the orthopedic department.” I asked, “This time why do you want to see my neurosurgery?” Old Yan said, “There is a patient in our community with symptoms similar to mine, was treated here in you, my partner asked me to come over to see, dissatisfied with you said, I have no hope.” Seeing Lao Yan’s disappointed look, I encouraged him and said, “Don’t be anxious, I will do a physical examination for you first, according to my judgment, your disease does not belong to orthopedics, it should belong to neurosurgery, and it can still be cured.” So I did a detailed examination of Old Yan and performed a spinal MRI of the thoracolumbar segment. After reading Lao Yan’s film, I said to Lao Yan, “According to my judgment, your disease is not a herniated lumbar disc or lumbar spinal stenosis, but a spinal vascular malformation.” Old Yan was a little stunned and asked, “Isn’t vascular malformation carried in the fetus? Only young people can get it, I’m already this old, will I still get this disease?” I explained, “There are many types of spinal cord vascular malformations, one of which is called dural arteriovenous fistula, is the most common, it occurs mostly in middle-aged and elderly people, mostly between the ages of 50 – 65 years old, your symptoms are more typical, many patients have been diagnosed with lumbar disc herniation, lumbar spinal stenosis, prostate hypertrophy and other diseases, ordinary spinal cord MRI or examination The part is not correct, often not found, if not properly treated, generally about 4 years, basically can not walk on the ground, but the legs can still move in bed.” Old Yan came to hear the spirit and asked, “So what should I do now?” I said, “You should first be hospitalized for a full spinal arteriogram, which is the only criterion for diagnosing this disease, and after the location of the vascular malformation is clarified, surgery will be performed to remove it. Lao Yan asked, “Isn’t it enough to have an MRI?” I knew that he had spent a lot of money unjustly over the years and was heartbroken, and I explained, “MRI can only look at an outline; to pinpoint the location of the malformed blood vessels, you must do a full spinal arteriogram, which is the gold standard for diagnosing this disease.” On the second day of hospitalization, I performed a total spinal arteriogram for Lao Yan, which confirmed a dural arteriovenous fistula located in the 9th thoracic segment. Three days later, Lao Yan underwent his fourth surgery, and the day after the surgery, the feeling of ants crawling on his legs was reduced. ” Two weeks after the surgery, Lao Yan began to practice getting out of bed with the help of his family. One Monday, six months later, Lao Yan came back to my clinic with crutches and said happily, “Look, Director Meng, I can walk again.” Dural arteriovenous fistula is a relatively common spinal cord vascular malformation that is easily misdiagnosed due to the lack of characteristic clinical signs and symptoms. Many neurosurgeons have pointed out that the main reason for misdiagnosis is the doctor’s lack of knowledge or understanding of the disease and the inappropriate or incomplete choice of examination methods. Therefore, as long as doctors have enough knowledge and understanding of the disease, choose the correct examination and treatment methods, early diagnosis and treatment (surgery or embolization), most patients can be completely cured. Meng Xiangjing, Department of Neurosurgery, Shandong Qianfo Mountain Hospital, Shandong Province, China Email: [email protected] This article is authorized by Dr. Meng Xiangjing.