Diagnosis and treatment of spinal vascular malformations

Spinal cord malformation is a rare but very dangerous disease that can lead to sudden paralysis or even death. Treatment of spinal vascular malformations aims to delay or preserve and avoid harm to the spinal cord.

Spinal Arteriovenous Malformation is a rare disorder in or near the spinal cord.
Normally, oxygen flows through the arteries to the capillaries that feed the spinal cord. The oxygen-depleted blood returns through the veins to the heart and lungs. In patients with spinal vascular malformations, blood flows directly from the arteries through the veins, but not through the capillaries. This condition deprives the surrounding tissues of the oxygen needed and causes the death of spinal cord tissue cells. Arteries and veins in spinal vascular malformations can rupture, causing bleeding. Occasionally, spinal vascular malformations can gradually increase in size over time because of increased blood flow, which puts pressure on the spinal cord causing disability and other complications.
The age group presenting with spinal vascular malformation is usually around 30 - 60 years old, more common in men than in women. Vascular malformations can occur in any segment of the spinal cord, but most commonly occur in the thoracic spinal cord, 7th and 8th thoracic spine segments. In a single patient, multiple vascular malformations in multiple segments can also occur. different marrow. The specific cause of the disease is still unknown. Most cases develop at birth, while others develop later in life.

The disease often progresses silently, without symptoms, so it is difficult to diagnose early. If the spinal vascular malformation is not treated in time, the disease can destroy the spinal cord, leading to complications such as difficulty moving; numbness, tingling sensation and pain; spinal cord defects; aneurysm; venous hypertension, which can cause edema and infarction of the spinal cord; hemorrhage; sudden paralysis or even death.

2.1 Diagnosis based on clinical symptoms Symptoms of spinal vascular malformations are varied, depending on the severity and location of the malformation. Many patients are asymptomatic for many years, but others develop life-threatening symptoms. The disease usually manifests itself by the age of 20, which can come on gradually or suddenly. Specific symptoms include:
Difficulty walking or climbing stairs; Feeling numbness, tingling or sudden pain in the legs or arms; Weakness on one or both sides of the body; Sudden severe back pain; Loss of sensation in the legs; Difficulty urinating; Headache; stiff neck; Urinary incontinence, urinary incontinence; Paralysis of limbs in severe cases; Localized back pain, mostly radiating to the waist and down to the legs; Sensitive to light. Patients should see a doctor if they have symptoms of spinal vascular malformations mentioned above. Early treatment of spinal vascular malformations will avoid dangerous complications caused by the disease.

2.2 Diagnosis based on necessary tests Magnetic resonance imaging (MRI): Is a test that uses a magnetic field and frequency waves to create detailed images of the spinal cord, helping the doctor to clearly observe and diagnose the main disease corpse. MRI can detect an aneurysm that is the result of abnormally connected blood vessels along with a spinal vascular malformation; Angiography: A test used to detect the location and characteristics of malformations of blood vessels. During the procedure, the doctor inserts a catheter into the femoral artery, which leads to the spinal cord. Contrast is injected into a blood vessel in the spinal cord to make blood vessel abnormalities show up on an X-ray, assisting the doctor in the diagnosis. Spinal vascular malformations should be differentiated from diseases: intramedullary neoplasm, epidural hematoma, transverse myelitis, spinal palsy, disease of the columns, intramedullary tract, disseminated encephalomyelitis, or disease cerebrospinal syphilis.

Treatment of vascular malformations is essential because otherwise, the patient may become disabled, die or have complications such as infection, sores due to immobilization, paralysis of both legs, urinary incontinence. ,... Treatment may include a combination of methods to relieve symptoms and reduce the risk of complications. Treatment options depend on the size, location, and blood flow of the malformation, the neurological exam, and the patient's general health. Specific treatment options are:
Medication: Using pain relievers can relieve the patient's symptoms of back pain but still requires surgical intervention.
Endovascular occlusion: An invasive procedure used to reduce the risk of bleeding and other complications associated with spinal vascular malformations. With this method, when performed, a catheter will be inserted into the leg artery leading to the spinal cord - where the vascular malformation is nourished. Then, small colloidal particles will be injected, causing embolism, reducing blood flow to the malformation, flattening the malformation, and preventing the malformation from bursting.
This procedure is often combined with spine surgery. Doctors can perform endovascular embolization before surgery to reduce bleeding during surgery or to reduce the size of the deformity, improving the success rate of surgery;
Surgery: Surgery to remove the deformity from the surrounding tissue. The closer the malformation is to the spinal cord, the more difficult the surgery and requires it to be performed by a qualified, experienced doctor. This method is often combined with an embolization procedure.

Spinal vascular malformation is a congenital disease, so there is no specific prevention measure. However, patients can prevent severe disease progression leading to paralysis or death by knowing the symptoms of the disease for early detection and timely treatment. If you see one or more symptoms such as numbness and weakness in the limbs, bladder and bowel dysfunction, severe localized back pain, etc., the patient should go to the hospital immediately for early diagnosis and treatment. .
Vinmec International General Hospital is currently applying the technique of digitizing and removing the background of the spinal cord malformation to treat patients with spinal vascular malformations, ruptured or dangerous AVMs. tall muscle.
Angiography and embolization of spinal arteriovenous malformation via endovascular intervention is performed by inserting intravascular instruments to the malformation and then injecting the embolization agent. The fovea of ​​the AVM may be located in the medulla, on the surface, or in the dural area that occludes the vascular malformation.
Techniques of digitalization and eradication of the spinal cord malformation have the advantage that the arteriovenous malformation is partially or completely occluded, and there is no longer dilated spinal cord veins. The anterior, posterior, and contralateral medullary arteries still circulate normally.