Wang was 68 years old when he developed numbness in his legs two years ago. When he walked a little farther, he felt that his legs were as weak as lead and had to rest for a while before he could continue walking. After carefully looking at the film, he found edema in the spinal cord and a tortuous vascular shadow behind the spinal cord, which was considered a dural arteriovenous fistula. The doctor recommended a spinal vascular DSA angiography, which confirmed a dural arteriovenous fistula located on the right side of the chest 11. The doctor recommended surgery to remove the fistula, and the surgery was completed successfully. The tortuous draining veins on the surface of the spinal cord were seen and the blood supply artery from the dura was found. After the surgery, Wang felt less numbness in his lower extremities and better strength in both legs than before the surgery. The cause of spinal dural arteriovenous fistula (SDAVF) is not well understood. It is now thought to be mostly an acquired disease, associated with a variety of factors such as infection, spinal cavernous disease, trauma and surgery. The pathogenesis of SDAVF is the direct communication between the arteries supplying the dura mater and the spinal drainage veins as they cross the dura mater at the intervertebral foramen. The pathogenic mechanism is mainly spinal venous hypertension, which impedes spinal venous return and leads to a decrease in spinal artery perfusion pressure, causing degeneration and necrosis of the spinal cord. Clinical manifestations are often insidious, slowly progressive, and progressively aggravated. It starts with a single sensory, motor or sphincter dysfunction, which may be accompanied by urinary and faecal and sexual dysfunction, and then progresses in an upward direction. The cone syndrome is the most common clinical condition, and simple localized pain in the nerve root area is rare. Because of the atypical symptoms, early diagnosis is difficult, and the condition is often serious by the time of consultation, with a 60.7% misdiagnosis rate reported in China. According to incomplete statistics, the average duration of disease in patients at the time of diagnosis has reached 18 months. The average duration of disease reported in the literature is 23 months. Magnetic resonance imaging is the preferred screening tool. Magnetic resonance scan shows worm-like vascular flow signals on the dorsal and ventral sides of the spinal cord, most clearly on T2 images, and enhanced scan shows enhanced signals of tortuous vessels on the spinal cord surface, and high-quality enhanced MRA shows the location of the blood supply artery and fistula. The spinal vascular DSA image showed that the arteries supplying the dura mater suddenly thickened in the spinal canal to the draining veins as its imaging feature. The draining veins are migrating, meandering, and dilated, slowing down blood flow and prolonging spinal venous circulation time. The ideal treatment is to permanently eliminate venous congestion in the spinal cord without affecting its blood supply and normal venous return. Current treatment options for dural arteriovenous fistulas include surgery, embolization, or a combination of both. The efficacy of microsurgery is definitive and permanent. Electrocoagulation and excision of the arteriovenous fistula is the most commonly used treatment. The disadvantage of surgery over embolization is that it is relatively more invasive and the diagnosis and treatment have to be done twice. Embolization can be attempted at the time of the first angiogram if there is a suitable vascular construct for embolization, especially in those who cannot tolerate surgery, in those with complex surgery in the sacrococcygeal or craniocervical junction area, and in those with multiple fistulas. Because embolization is less invasive, diagnosis and treatment can be completed in one visit, and the patient recovers more quickly after treatment. The disadvantage of embolization is that the efficacy remains uncertain and the recurrence rate is relatively high. In cases of high flow or multiple fistulas, combined therapy is advocated to overcome the disadvantages of surgery or embolization alone. Increasing attention is being paid to whether to anticoagulate after surgery. After the fistula is blocked, the pressure in the perimedullary coronary plexus decreases by an average of 38.3%, and the dysfunction caused by venous hypertension is quickly restored, while the coronary plexus is mostly slow or no flow signal on Doppler ultrasound, resulting in “venous stasis”. This predisposes to intravenous thrombosis. The lower the location of the fistula, the higher the probability of thrombosis. Anticoagulation is performed within 24 to 48 h after embolization or surgery, usually with oral warfarin, to maintain prothrombin time at 2 to 3 times normal and activity at 30% of normal. To avoid postoperative bleeding, close attention should be paid to changes in the condition, and anticoagulation should be terminated if bleeding occurs. The duration of anticoagulation is usually 1 to 3 months.