1.Understanding spinal cord vascular malformation
Spinal cord vascular malformations are abnormal vascular structures that appear in, on, or near the spinal cord. The spinal cord, like other organs and tissues in the body, requires arteries to transport blood to the cells of the capillary nourishing tissues, and then veins to drain the blood back to the heart. It is these vessels that produce the abnormal growths that lead to spinal cord vascular malformations.
When spinal cord vascular malformations occur, they may damage the body in several ways, resulting in symptoms.
(1) When the malformation occurs, blood flows directly from the arteries to the veins, bypassing the capillaries, thus causing the normal spinal cord cells to die of ischemia.
(2) The malformed arterial or venous vessels are fragile and can easily rupture, leading to spinal cord hemorrhage.
(3) Sometimes the malformed vascular mass enlarges, thus compressing the normal spinal cord.
(4) The abnormal blood flow produced by the malformed vascular mass occupies the channels for venous drainage, preventing normal spinal cord venous blood from returning to the heart, resulting in spinal cord stasis and venous hypertension. This is a rare and complex disease, and there are no accurate data on its incidence.
2. Spinal cord vascular malformation is a collective term for a large group of diseases
The structure of the spinal column consists of the bony spinal canal and the soft spinal cord inside. The spinal cord is surrounded by membranes between the bony structures of the spinal canal – the arachnoid membrane and the dura mater, respectively. Spinal vascular malformations can then be classified into the following categories based on the location where they occur and the type of malformation mass.
(1) malformations occurring within the spinal cord and manifesting mainly as abnormal intertwined malformed arterioles, called spinal arteriovenous malformations, which account for about 33% of the total.
(2) malformations occurring in or around the spinal cord, mainly manifesting as abnormal arterial and venous communication, called spinal arteriovenous fistula, accounting for about 12% of the total.
(3) The dural arteriovenous fistula, which involves the dura mater alone and mainly shows abnormal arterial and venous communication, accounts for about 32% of the total number of cases.
(4) The deformity involves the vertebral body, the skin and muscles outside the vertebral body, the dura mater and the spinal cord and other structures inside the spinal canal, which is called spinal vascular malformation of the spinal column, also called Cobb’s disease, accounting for about 7% of the total; in addition, there are more rare epidural arteriovenous malformations, paravertebral arteriovenous malformations, etc.
3.How do I get spinal cord vascular malformation?
The spinal cord, like other organs and tissues in the body, requires arteries to transport blood to the cells of the capillary tissues, and then veins to drain the blood back to the heart. This abnormal development usually occurs in the early stages of fetal development and does not have obvious heredity.
4.Can spinal vascular malformation be prevented?
Because spinal vascular malformations are often caused by abnormal embryonic development, there is no clear cause for their occurrence. Therefore, it is not possible to prevent the occurrence of spinal cord vascular malformation lesions. However, MRI scans of the spinal cord can detect the disease in time for proper and effective treatment and improve the prognosis.
5.What are the symptoms of spinal vascular malformation?
The clinical manifestations of spinal cord vascular malformation are mainly related to the impaired function of the spinal cord, and we all know that human movement, sensation, and urination and defecation are all related to the spinal cord. When spinal vascular malformation occurs, it leads to the impairment of spinal cord function, which is mainly manifested in three symptoms.
(1) sensory abnormalities, such as pain, numbness in the limbs, and abnormal sensation to hot and cold.
(2) Motor impairment, such as weakness of one or both limbs.
(3) abnormalities of urination and defecation, including constipation, difficulty in urination, incontinence, etc.
6.The identification of acute bleeding of spinal cord vascular malformation
Spinal cord vascular malformation shows symptoms in two ways: acute and slow progression, while the sudden manifestation of symptoms is often due to acute bleeding of the malformation mass. This kind of emergency requires high attention, an MRI examination as soon as possible to clarify the diagnosis, and transfer to a hospital with treatment capability.
Acute back or lumbar pain can occur immediately after a spinal cord hemorrhage and can spread rapidly into limb paralysis, loss of sensation, and incontinence. This process often occurs sharply within 1 day. In the case of intramedullary hemorrhage in the upper cervical segment, it can affect the patient’s breathing and death can occur within hours or days in severe cases.
7.The main diagnostic tools of spinal vascular malformation
When we consider the diagnosis of spinal vascular malformation based on the patient’s clinical symptoms, we recommend that the patient undergo the following tests in sequence.
(1) Spinal cord MRI: It is the preferred method to detect the disease. (1) MRI of the spinal cord: It is the first choice for detecting the disease. It provides a complete picture of the location, size, and whether there is bleeding of the spinal vascular malformation mass.
(2) Spinal cord vascular CTA: It can quickly identify the abnormal vessels where the lesion occurs initially and guide the subsequent angiography.
(3) Spinal cord angiography: It is the only method to confirm the diagnosis of spinal cord vascular malformation, which can clarify the structure and location of the abnormal vessels and also evaluate the treatment methods that can be used. Spinal angiography is also the basis of embolization treatment.
8.Treatment of spinal cord vascular malformation
The treatment of spinal cord vascular malformation includes two main types of treatment methods.
(1) surgical resection: that is, surgical methods to reach the lesion and remove the abnormal blood vessels.
(2) Interventional embolization: the abnormal vessels are densely embolized with embolic material through micro catheters and micro guidewires, which are used to reach the lesion along the blood vessels in the body under X-ray fluoroscopy.
Because spinal vascular malformation is a very complicated disease, most patients need a combination of the above two methods and multiple treatments in stages.
9.What is a complex surgery for spinal vascular malformation?
A high-tech complex surgery room is a room where both surgery and intraoperative angiography can be performed in real time. The composite surgery for spinal cord vascular malformation is to use the composite surgery room to differentiate normal and abnormal vessels through intraoperative real-time spinal cord angiography to guide the surgery and ensure complete resection, thus improving the accuracy of surgical resection and complete resection rate. The composite surgery for spinal vascular malformation started in 2013, which has brought the treatment of spinal vascular malformation to a new level.
10.The purpose of treatment of spinal cord vascular malformation
In clinical practice, the complete removal of anomalous vascular malformations by surgery or interventional embolization marks the cure of the patient. At the same time, the function of the spinal cord is crucial, and if the injury can cause lifelong sensory or motor impairment in patients, the aim of our treatment is to remove the malformed vascular mass as much as possible, while trying to ensure that the normal spinal cord function of the patient is not damaged or less lost.
11.Why is spinal cord vascular malformation a worldwide problem?
(1) The disease is a rare disease with a small number of cases, and the understanding of the disease needs long-term accumulation.
(2) The disease is a difficult disease, and the abnormal vascular architecture is complex, which requires long-term research and study. And a clear understanding of the vascular structure is the basis of treatment.
(3) Even if the understanding is clear, because the spinal cord tissue is delicate and there is little room for error, the slightest inadvertence will cause serious complications, so it requires high surgical skills and long training.
12.Is spinal cord arteriovenous malformation easily misdiagnosed and what kind of disease is it most likely to be misdiagnosed as?
It is easy to be misdiagnosed because it is a rare disease and many doctors do not know enough about it, so it is easily misdiagnosed as disc herniation, myelitis, prostate enlargement, etc.
13.What is spinal arteriovenous malformation?
Spinal cord arteriovenous malformation is a kind of spinal cord vascular malformation, which refers to the abnormal growth of arteries supplying spinal cord tissue and veins draining the spinal cord to form a trabecular vascular cluster. These abnormal arterioles and veins are referred to as aberrant vascular masses. The presence of aberrant vascular masses produces corresponding symptoms of impaired spinal cord function.
14.What is Cobb’s disease?
Cobb’s disease is a spinal cord vascular malformation syndrome that involves a wide range of areas, including the paravertebral skin, muscles, vertebral bodies, as well as the dura mater and spinal cord within the spinal canal, and the lesions are often segmental in nature. This patient can sometimes see coffee-colored spots on the skin surface.
15.What is a dural arteriovenous fistula?
Dural arteriovenous fistula is a kind of spinal vascular malformation, in which the arterioles on the epidural surface communicate directly with the veins in the dura mater, resulting in poor drainage of the normal veins of the spinal cord and spinal cord stasis, which causes a series of symptoms, starting with a single sensory, motor or sphincter dysfunction, such as asymmetric burning or ankylosis in both lower extremities, intermittent claudication, etc. In severe cases, there can be inability to urinate or defecate or incontinence, limb paralysis, etc. In severe cases, there may be inability or incontinence of urine and stool, and limb paralysis.