Debridement

Abstract

<b>Objective:</b> To ascertain clinical predictors of final diagnosis of spinal dural arteriovenous fistulas (SDAVF) in patients with myelopathy. <b>Background:</b> SDAVF are an uncommon but treatable cause of myelopathy. This study explores clinical factors which predict SDAVF in the setting of radiographic lesions concerning for demyelination. <b>Methods:</b> We performed a retrospective chart review of PACS imaging system for the term “spinal dural arteriovenous fistula” to obtain cases. Inclusion criteria included any confirmed case of SDAVF. We performed another retrospective chart review of PACS for the term “demyelinating” to serve as controls. Inclusion criteria included any demyelinating lesion in the spinal cord. Exclusion criteria included previous diagnosis of demyelinating lesion. The SDAVF group was compared with the demyelinating group across demographics, vascular risk factors, smoking history, spinal cord lesion level on MRI, and back pain symptoms using t-test or Chi-square analyses. Multivariate analysis was used to further evaluate if these factors had any predictive value. <b>Results:</b> SDAVF patients were significantly older (mean 65.5 vs. 39.2, p&lt;0.001), more likely to be male (80[percnt] vs 35.6[percnt], p&lt;0.001), more likely to have vascular risk factors (65[percnt] vs. 26[percnt], p=0.001), more likely to have back pain (50[percnt] vs. 18[percnt], p=0.004), less likely to have cervical lesions (25[percnt] vs. 69[percnt], p&lt;0.001), and more likely to have thoracic (80[percnt] vs 49[percnt], p=0.008) and lumbosacral lesions (40[percnt] vs. 3[percnt], p&lt;0.001). Multivariate analysis showed age (OR=1.14, 95[percnt] CI 1.06-1.22), back pain (OR=5.33, 95[percnt] CI 1.13-25.14) and lumbosacral lesions (OR11.20, 95[percnt] CI 1.31-95.98) predict SDAVF. Cervical lesions predict that patients are less likely to have SDAVF (OR=0.18, 95[percnt] CI 0.04-0.84). <b>Conclusions:</b> Patients are more likely to have SDAVF than a demyelinating lesion if they are male, present at an older age, with back pain, and with lumbosacral lesions, and less likely with cervical myelopathy. <b>Disclosure:</b> Dr. Tipirneni has nothing to disclose. Dr. Tipirneni has nothing to disclose. Dr. Atchaneeyasakul has nothing to disclose. Dr. Bleicher has nothing to disclose. Dr. Yavagal has received personal compensation for activities with Covidien/evV3 as a consultant and Steering Committee Member.