ARTERIOVENOUS MALFORMATION OF THE SPINE
Spinal arteriovenous malformation (AVM) is a tangle of blood vessels on, in, or near the spinal cord. Without treatment, this rare condition can permanently damage the spinal cord.
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Arteriovenous Malformation (AVM) Spine
Blood vessels tangled on, inside, or next to the spinal cord are known as spinal arteriovenous malformations (AVM). Blood flows directly from the arteries to the veins and circumvents the capillaries in a spinal AVM. As a result of this alteration in blood flow, the surrounding cells do not receive the necessary oxygen. Therefore, the cells in the spinal tissue may deteriorate or pass away. In addition, a spinal AVM’s convoluted arteries and veins may potentially burst and result in spinal cord bleeding (hemorrhage). As blood flow rises and pushes on the spinal cord, the AVM may occasionally develop over time, causing disability or other issues. Before a patient gets suffering symptoms, they might not know that they have a spinal AVM. Eventually, surgery can stop or perhaps restore some of the spinal damage caused by the illness.
This unusual illness has the potential to irreversibly harm the spinal cord if left untreated. Even though many patients have no symptoms, bleeding is the initial sign of an AVM in 50% of cases. Despite the fact that AVMs are present from birth, symptoms frequently don’t appear until later in life, between the ages of 20 and 40, when the ailment has already advanced and most adults do not experience any negative health effects. However, life-threatening complications only impact 1% of individuals affected. Finally, doctors normally will find an AVM while testing other conditions.
Arteriovenous Malformation Symptoms
Usually, arteries that branch into smaller blood vessels allow oxygen-rich blood to enter the spinal cord (capillaries). The blood in the capillaries supplies the spinal cord with oxygen. After that, the blood enters veins that carry it to the heart and lungs while draining blood away from the spinal cord. Anywhere in the body can experience an AVM. Neurological AVMs are what they are known as when they occur in the spinal cord and brain. These are more likely to result in symptoms in certain body areas. Furthermore, spinal AVMs do not always cause symptoms, but doctors consider them as dangerous, especially when they start to cause symptoms. Certainly, a doctor should check for suspicious symptoms. These may include:
- Muscles that feel weak
- Muscle paralysis
- Problems with coordination and balance (ataxia).
- Unusual feelings, including tingling or numbness, or discomfort.
QUESTIONS AND ANSWERS
What is Arteriovenous Malformation of the Spine?
An Arteriovenous Malformation (AVM) of the spine refers to an abnormal tangle of blood vessels in the spinal cord. It involves a direct connection between arteries and veins, bypassing the capillary network. This vascular anomaly disrupts normal blood flow, potentially causing neurological symptoms and complications.
What are the symptoms of Arteriovenous Malformation of the Spine?
Symptoms of spinal AVM can vary widely and may include back pain, numbness or weakness in the limbs, difficulty walking, loss of bladder or bowel control, and even paralysis. Severe cases can lead to bleeding within the spinal cord, which may result in sudden and severe neurological deficits.
How is Spinal Arteriovenous Malformation Diagnosed and Treated?
Diagnosis of spinal AVM involves a combination of medical history, physical examination, and imaging studies such as MRI and angiography. Treatment options depend on the location, size, and severity of the AVM. In some cases, doctors will recommend observing the AVM if it appears small and asymptomatic. However, treatment may involve embolization (blocking blood flow to the AVM), surgical removal, or radiation therapy to shrink the abnormal blood vessels. The choice of treatment becomes determined by a team of specialists, including surgeons and interventional radiologists, based on the individual’s condition and overall health. Doctors will advise that early intervention becomes crucial to prevent potential complications and improve long-term outcomes.
Schedule an appointment to have your child seen at Medical City Children’s Orthopedic and Spine Specialists for a condition called Arteriovenous Malformation of the Spine.
Although over 20% of spinal AVM diagnoses are made in patients under the age of 16, symptoms often start to appear in persons in their 20s. Also, AVM symptoms and signs can vary from person to person and might include:
- Headache
- Legs losing their feeling
- Neck stiffness
- Legs that are numb or tingly
- Sensitivity to light
- Sudden back pain
- Sudden pain in the legs
- problematic urination or bowel movements
- Having trouble ascending stairs or walking
- A weakened side or both of the body
Arteriovenous Malformation Causes
What causes AVMs is unknown. Some medical professionals think they develop during pregnancy or soon after delivery and manifest as the kid becomes older. The skin of newborns with AVM disease may have a blue color. This results from the body not having enough oxygenated blood flowing through it. As youngsters become older and the illness gets worse, the skin usually darkens to a deep red or purple color. Spinal AVMs have no established risk factors, however, they may seldom run in families. The sickness equally affects both males and women.
Diagnosis
Since the symptoms of spinal arteriovenous malformations are similar to those of other spinal illnesses such as spinal stenosis, multiple sclerosis, spinal Dural arteriovenous fistula, and spinal cord tumors, doctors will find them challenging to identify. If as a parent you have any indications or symptoms of your child having a neurological system issue, such as persistent headaches, seizures, or trouble regulating muscles, you should make an appointment to see a doctor. To help rule out further reasons for the symptoms, your doctor may order the following tests:
- Magnetic resonance imaging (MRI) uses powerful magnets and radio waves to make detailed pictures of the spinal cord.
- Spine MRI can identify masses caused by irregularly connected blood vessels associated with an AVM.
- Angiography, which is a thin tube (catheter) that is inserted into an artery in the groin and travels to the spinal cord. The dye is injected into the spinal cord blood vessels and visualized by X-ray.
Arteriovenous Malformation Treatment
In order to diminish symptoms and lower the possibility of consequences, treatment for spinal AVM may combine several methods. The type of treatment your child receives is determined by the spinal AVM’s size, location, and blood flow, the findings of the neurological exam, and the child’s general health.
Simple spinal arteriovenous malformations may require surgery. Our expert surgeon at Medical City Children’s Orthopedics and Spine Specialists, with offices in Arlington, Dallas, Flower Mound, Frisco, and McKinney, TX, will perform surgery to correct your child’s deformity and return to normal blood flow. He or she will utilize a microscope and small equipment. Your child’s hospitalization may be shortened because of the minimally invasive technique. Treatment for spinal AVMs aims to lessen bleeding risks and slow or halt the deterioration of symptoms including impairment. Normally, arteries in your child’s body branch into capillaries, which are smaller blood vessels, to provide oxygen-rich blood to the spinal cord.
The oxygen-rich blood in your capillaries is what your spinal cord depends on. A vein that transports blood from your spinal cord to your heart and lungs ultimately picks up the blood with low oxygen content. When an arteriovenous malformation develops, blood bypasses the capillaries entirely and travels straight from the arteries to the veins. Untreated spinal arteriovenous malformations can permanently harm your child’s spinal cord and cause sensory and motor impairments. Ruptured spinal AVMs can be dangerous and they can induce bleeding in nearby locations. By squeezing or redirecting blood from certain areas of the spinal cord, AVMs can also produce symptoms.
Medication
Despite the fact that drugs cannot treat AVMs, your doctor may nonetheless prescribe them. Medication manages seizures and pain.
Surgery
Doctors may find the need for specific circumstances. Surgeons can remove the abnormality using a surgical microscope and incredibly fine equipment to restore normal blood flow.
Conventional surgery
In this operation, a surgeon makes a skin incision to remove the AVM while taking care not to injure the spinal cord or other nearby structures.
Endovascular embolization
Embolization is a minimally invasive radiologic surgery that involves inserting tiny catheters into arteries to introduce glue or other obstructive substances into the AVM in order to stop the flow of blood through the abnormality. The length of the surgery might vary, and the patient must stay in the hospital for supervision for a few days. Doctors may find the need for several treatments. To lower the risk of bleeding during surgery or to diminish the AVM so that surgery is more effective, your surgeon may suggest endovascular embolization before other forms of surgery.
Radiosurgery
Radiation beams are expertly targeted and directed toward the aberrant vessels during radiosurgery. The Leksell Gamma Knife and linear accelerator systems are the two major technologies. The preparation for the surgery takes many hours, and the radiation delivery takes an hour. The patient gets released that same day. The veins progressively seal off and are replaced by scar tissue after 6 months to 2 years. This therapy has the benefit of not requiring an incision and being painless. The drawbacks include the fact that it works best with smaller AVMs and may take a while to manifest (during which time the risk of hemorrhage exists). You and your doctor should go over the advantages and disadvantages of having your child’s AVM surgically removed.
Arteriovenous Malformation Prevention
Doctors and surgeons cannot stop AVMs. With the right medical treatment, parents can manage and treat your child’s symptoms. Taking the recommended prescriptions will help your child stay away from issues with bleeding, discomfort, and other consequences. Maintaining frequent consultations with a pediatric orthopedist to control high blood pressure, and avoiding drugs that thin the blood can all help you keep track of your child’s health and avoid problems. Parents may take care of the physical and mental health of their children by having them conduct activities like the following:
Avoiding Strenuous Exercise
Children with AVMs who take medicine for the condition may need to avoid vigorous activity since it might increase blood pressure.
Avoiding Certain Medications
AVM sufferers should stay away from drugs like blood thinners that might make bleeding more likely.
Learning About AVMs
Parents should know about AVMs and their repercussions. Being fully knowledgeable will allow parents to provide better care for their child and the potential AVM hazards. Additionally, it can assist in defining an AVM for other people.
Arteriovenous Malformation Complications
Your child’s spinal cord may suffer damage if spinal AVMs are left untreated — because the spine cannot obtain the oxygen it requires from the blood. Additionally, a spinal AVM may hemorrhage. The spinal arteriovenous malformation can result in impairment that worsens over time if untreated. This is a result of tissue injury to the spinal cord and its surroundings. These issues might involve:
- Having trouble moving (motor deficits)
- Numbness, tingling, and discomfort (sensory deficits)
- Spine-column malformation
- Expanded blood vessel (aneurysm)
- Venous hypertension, or increased blood pressure in the veins, can result in fluid retention (edema) and tissue death from a lack of oxygen (spinal cord infarction)
- Blood loss, which accelerates spinal cord injury
Medical City Children’s Orthopedics and Spine Specialists
In order to create a treatment plan, our surgeons take into account a patient’s clinical history, symptoms, physical examination, and spinal angiography findings. Endovascular embolization refers to a treatment used to treat spinal AVMs. This method includes inserting a small catheter, or tube, into the blood arteries supplying the AVM without the need for surgery. Once in position, the catheter discharges a liquid-like substance or minute particles that can completely or partially seal off the abnormality. However, this surgery might not always end-up successful due to factors relating to blood flow and vascular structure.
Another nonsurgical treatment that may eliminate the aberrant vessels of an AVM is radiation therapy, commonly known as stereotactic radiosurgery. Surgery may be necessary for specific circumstances. Surgeons at Medical City Children’s Orthopedics and Spine Specialists may microsurgically remove the abnormality to return the normal blood flow by using a surgical microscope and incredibly fine equipment. Since spinal AVMs are complicated lesions, pediatric orthopedists with experience in doing so, like those at Medical City Children’s Orthopedics and Spine Specialists should be the professionals to help your child
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Footnote:
National Library of Medicine: Arteriovenous Malformation of the Spine
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