ABSTRACT
Spinal arteriovenous malformations are united by the existence of arteriovenous shunting but are quite heterogeneous in terms of pathology. Until recently, the pathological confusion has been such that management has been poorly understood and this is magnified by the rarity of the lesions. Type 1 AVMs, where the fistula is located in the dura, usually present with a venous hypertensive myelopathy and are relatively easily dealt with surgically. Type 2 AVMs, most closely mimicking the parenchymal AVMs of the brain, usually present with haemorrhage and may be surgically remediable but with much greater risk than the type 1 lesions. Type 3 AVMs, with a diffuse location through both the cord and extra-CNS tissue, usually present early in life with a myelopathy and are often untreatable. Type 4 AVMs, with a fistula located on the pial surface of the cord, usually present with a venous hypertensive myelopathy or subarachnoid haemorrhage, can be treated relatively easily by surgery when small but may be better treated endovascularly when the fistula is large. The purpose of this review is to summarise the current pathological, clinical and management literature with illustrative cases underscoring the important features of this heterogeneous disorder.
Subject(s)
Arteriovenous Malformations/pathology , Central Nervous System Vascular Malformations/pathology , Spinal Cord/blood supply , Adult , Aged , Angiography , Arteriovenous Malformations/surgery , Central Nervous System Vascular Malformations/surgery , Female , Humans , Magnetic Resonance Imaging , Male , Middle AgedABSTRACT
The plain X-rays and CT scans of 23 cases of thoracolumbar and 18 cases of lower cervical (below C2) spinal compression fractures were compared. A new picture of the fracture pathology has emerged as several features consistently appeared and are described: a midline or slightly oblique split of the vertebral body; posterolateral fractures of the body in the region of the developmental neurocentral joint; fragments of the body displaced backwards into the canal at the level of the pedicles; oblique laminal fractures; and separation of the zygapophyseal rim in thoracolumbar fractures. With this more complete picture of the bony injury, in particular canal encroachment, a new method of anterolateral canal decompression has been tried and is described.
Subject(s)
Cervical Vertebrae/injuries , Fractures, Bone/pathology , Lumbar Vertebrae/injuries , Thoracic Vertebrae/injuries , Adolescent , Adult , Cervical Vertebrae/diagnostic imaging , Female , Fractures, Bone/complications , Fractures, Bone/diagnostic imaging , Fractures, Bone/surgery , Humans , Lumbar Vertebrae/diagnostic imaging , Male , Methods , Paraplegia/etiology , Thoracic Vertebrae/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
A case of a 12-year-old boy, in whom a partial Brown-Séquard's syndrome developed after a gunshot injury to the back of the neck, is reported. The bullet, which was removed at operation, penetrated the left side of the spinal cord at the cervicomedullary junction. The patient recovered useful function in his left leg within a month after the injury, and was able to walk with the aid of a crutch on discharge from hospital. The case is unusual, because of the survival and subsequent good recovery of the patient after a high, penetrating injury of the spinal cord.
