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A Descriptive Analysis of Spinal Cord Arteriovenous Malformations: Clinical Features, Outcomes, and Trends in Management. World neurosurgery Varshneya, K., Pendharkar, A. V., Azad, T. D., Ratliff, J. K., Veeravagu, A. 2019


BACKGROUND: Spinal arteriovenous malformations (AVM) are an abnormal interconnection of vasculature in the spine than can lead to significant neurological deficit if left untreated.OBJECTIVE: The objective of this study was to characterize how spinal AVM patients initially presented, what treatment options were utilized, and their overall outcomes on a national scale.METHODS: The MarketScan database was queried to identify adult patients diagnosed with a spinal AVM from 2007 - 2015. Trends in management, postoperative complication rates, and costs were determined.RESULTS: 976 patients were identified with having a diagnosis of a spinal AVM. Patients were more commonly treated with an open incision than an embolization (40.1% vs 15.4%). The overall complication rate was 33.61%. Spinal AVM admissions have been stable over the past decade and mean cost of hospitalization has risen from of $48,700 in 2007 to $71,292 in 2015. Patients who underwent open surgery had a higher complication rate than those treated with embolization (31.15% vs 18.25%, p < 0.005); however, this may be strongly influenced by complexity of spinal AVM pathology and not treatment modality.CONCLUSIONS: Costs of spinal AVM management continue to rise, even when treatment modalities have reduced length of stay significantly. Open surgery may lead to more postoperative complications and a higher length of stay than endovascular approaches. Further studies should look to identify the efficacy of endovascular approaches for spinal cord AVMs, particularly in complex spinal AVM traditionally treated with open surgery and to isolate factors leading to the elevated hospitalization costs.LEVEL OF EVIDENCE: III.

View details for DOI 10.1016/j.wneu.2019.08.010

View details for PubMedID 31404690