title: Large spinal intraosseous arteriovenous fistula: case report.
abstract: Here the authors report the case of a fresh vertebral body fracture with a large spinal intraosseous arteriovenous fistula (AVF). A 74-year-old woman started to experience low-back pain following a rear-end car collision. Plain radiography showed diffuse idiopathic skeletal hyperostosis (DISH). Sagittal CT sections revealed a transverse fracture of the L-4 vertebral body with a bone defect. Sagittal fat-suppressed T2-weighted MRI revealed a flow void in the fractured vertebra. Spinal angiography revealed an intraosseous AVF with a feeder from the right L-4 segmental artery. A fresh fracture of the L-4 vertebral body with a spinal intraosseous AVF was diagnosed. Observation of a flow void in the vertebral body on fat-suppressed T2-weighted MRI was important for the diagnosis of the spinal intraosseous AVF. Because conservative treatment was ineffective, surgery was undertaken. The day before surgery, embolization through the right L-4 segmental artery was performed using 2 coils to achieve AVF closure. Posterolateral fusion with instrumentation at the T12-S2 vertebral levels was performed without L-4 vertebroplasty. The spinal intraosseous AVF had disappeared after 4 months. At 24 months after surgery, the bone defect was completely replaced by bone and the patient experienced no limitations in daily activities. Given their experience with the present case, the authors believe that performing vertebroplasty or anterior reconstruction may not be necessary in treating spinal intraosseous AVF.
authors: Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
authors: Yasuaki
authors: Y
authors: Imajo
authors: Tsukasa
authors: T
authors: Kanchiku
authors: Yuichiro
authors: Y
authors: Yoshida
authors: Norihiro
authors: N
authors: Nishida
authors: Toshihiko
authors: T
authors: Taguchi
mesh_terms: D000368:Aged; D001164:Arteriovenous Fistula / Q000175:diagnosis* / Q000601:surgery*; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008159:Lumbar Vertebrae / Q000098:blood supply* / Q000293:injuries*; D008279:Magnetic Resonance Imaging; D011300:Preoperative Care; D012447:Sacrum / Q000601:surgery; D013122:Spinal Diseases / Q000175:diagnosis* / Q000601:surgery*; D016103:Spinal Fractures / Q000175:diagnosis* / Q000601:surgery*; D013123:Spinal Fusion; D013904:Thoracic Vertebrae / Q000601:surgery; D014057:Tomography, X-Ray Computed
keywords: AVF = arteriovenous fistula; DISH = diffuse idiopathic skeletal hyperostosis; lumbar spine; oncology; spinal intraosseous arteriovenous fistula; surgical treatment