Correlation between time to diagnosis and rehabilitation outcomes in patients with spinal dural arteriovenous fistula

Abstract

BackgroundSpinal dural arteriovenous fistulas (SDAVFs) are the most common spinal vascular malformations and can be a significant cause of myelopathy although they are under diagnosed. Surgical or embolization treatment of SDAVFs improved significantly in the last decade. However, a high percentage of patients are still left with severe disability.ObjectiveTo describe the correlation between time to diagnosis and the rehabilitation outcomes of eight patients with SDAVFs.DesignRetrospective chart study of all SDAVF patients in 20 years.SettingA tertiary university rehabilitation center.Main outcome measuresThe lower extremities motor score (LEMS), Functional Independence Measure (FIM), Spinal Cord Independence Measure (SCIM) and Walking Scale for Spinal Cord Injury (WISC II). Overall prognosis was evaluated using the Aminoff-Logue scale (ALS).ResultsThere were seven men and one woman with mean age of 61.3 ± 15 (30–72) and mean time until the diagnosis of SDAVF of 265.5 ± 245 days (4–730). At the end of rehabilitation period, five of the eight patients remained wheelchair dependent. Strong correlation was found between LEMS, FIM, SCIM, and WISC II scores and the functional level according to the ALS scale. A significant correlation was found between time to diagnosis and the height of the SDAVF, the clinical and rehabilitation outcomes. Patients with high SDAVF which were diagnosed late had the poorest prognosis.ConclusionsThe potential for functional ambulation in patients with SDAVF is related to the time of intervention. This finding emphasizes the important of early diagnosis and early intervention in SDAVF.