Spinal Vascular Malformations

Conditions Treated

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Overview

Spinal vascular malformations (AVMs and other lesions) are abnormal blood vessel formations within or near the spinal cord. They can cause cord compression, ischaemia (reduced blood flow) or haemorrhage, leading to pain and neurological symptoms. Diagnosis is made with imaging and angiography, and treatment may include embolisation, surgery or close monitoring.

Symptoms

Back or neck pain, sometimes radiating down an arm or leg.
Progressive weakness or loss of strength.
Numbness or tingling below the level of the malformation.
Gait disturbance and difficulty walking.
Loss of pain or temperature sensation.
In some cases, pulsatile tinnitus (hearing a heartbeat-like sound in the head/neck).
Sudden onset of severe symptoms may indicate haemorrhage (requiring urgent assessment).

Causes

Vascular malformations result from abnormal development of blood vessels:

Spinal AVMs: abnormal direct connections between arteries and veins, causing high blood flow and potential cord damage.
Cavernomas: collections of abnormal vessels prone to bleeding.
Venous angiomas: slow-flow malformations in venous drainage.
Dural AVFs: arteriovenous fistulas in the dura (spinal cord covering).

Malformations can be congenital (present from birth) or acquired. Some are associated with hereditary syndromes.

Diagnosis

MRI with contrast: initial imaging showing malformation, cord changes (swelling, signal changes) and bleeding if present.
MR angiography: shows blood flow through the malformation.
Selective spinal angiography: gold standard for detailed vascular anatomy; essential for planning treatment.
CT angiography: alternative if angiography is not feasible.

Non‑surgical treatment

Some malformations, particularly small, asymptomatic lesions, may be managed conservatively with surveillance.

Serial imaging: regular MRI follow-up to assess for growth, new bleeding or cord changes.
Symptom management: pain control and physiotherapy for weakness.
Monitoring for haemorrhage: discussion of red-flag symptoms warranting urgent assessment.

However, progressive symptoms, cord signal changes or haemorrhage typically warrant intervention.

Surgical treatment

Definitive treatment aims to obliterate the malformation and prevent cord damage.

Endovascular embolisation: minimally invasive catheter-based technique to block abnormal vessels; often performed first-line or as sole treatment.
Surgical resection: removal of the malformation, particularly for lesions not amenable to embolisation or after haemorrhage.
Combined approach: embolisation followed by surgery if needed to achieve complete obliteration.
Radiosurgery: stereotactic radiosurgery may be used for selected lesions.

Treatment choice depends on malformation type, location, vascular anatomy and symptoms.