• Norimitsu Wakao, Shiro Imagama, Zenya Ito, Kei Ando, Kenichi Hirano, Ryoji Tauchi, Akio Muramoto, Hiroki Matsui, Tomohiro Matsumoto, Yukihiro Matsuyama, and Naoki Ishiguro.
• Department of Orthopedic Surgery, Nagoya University, Nagoya City, Aichi, Japan. nwakao@med.nagoya-u.ac.jp
• Spine. 2012 Mar 15; 37 (6): 482-8.

Study DesignThis study was a case series study using a prospective single-institute database for the treatment of spinal dural arteriovenous fistulas (SDAVFs).ObjectiveTo evaluate clinical factors that influence the neurological outcomes of treatment for SDAVFs, which were obtained from the analysis of 21 patients treated in our institution, and to provide management recommendations based on the review of former major clinical studies including our own reported over the past 2 decades.Summary Of Background DataSince 1977, when Kendall and Logue described the etiology of SDAVFs as hyperpressure of intrathecal veins due to an abnormal shunting from the arteries, treatment strategies have improved dramatically along with developments in neuroimaging, endovascular techniques and materials, and microsurgery based on the underlying pathophysiological process. However, therapeutic guidelines remain controversial.MethodsPatients treated for SDAVFs from 2000 to 2008 were eligible. Age, sex, level of shunting, initial symptom, duration of symptom, the treatment method, and clinical symptoms before and 6 months after treatment were investigated.ResultsThere were a total of 30 patients (18 male and 12 female), with a mean age of 59 years; 21 of them underwent treatment for the first time. We conducted a univariate analysis using a logistic regression model, on age, sex, the level of SDAVFs, duration of symptoms, symptom (sensory or paralysis), and gait function and micturition before treatment, and the intervention method were set as variables to investigate the risk factors for motor deficit 6 months after the treatment. Only gait function before treatment was correlated with the motor deficit 6 months after treatment (odds ratio = 10.0; 95% confidence interval = 1.28-78.11, P = 0.03).From these results, intervention at an early stage would be the key to a preferable outcome of the treatment for SDAVFs.ConclusionThe clinical status before treatment significantly influenced the clinical outcome after the treatment.

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