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Arteriovenous malformations and back pain
Last reviewed: 04.07.2025
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Arteriovenous malformations within or around the spinal cord may cause spinal cord compression, parenchymal hemorrhage, subarachnoid hemorrhage, or a combination of these. Symptoms may include gradually progressive ascending or ascending and descending segmental neurologic deficits, radicular pain, or sudden back pain with acute segmental neurologic deficits. Diagnosis is by MRI. Treatment is surgical or stereotactic radiosurgery, and angiographic embolization may also be considered.
Arteriovenous malformations are the most common vascular spinal anomalies. They are most common in the thoracic and lumbar regions in the posterior portions of the extramedullary space. Others are located in the cervical and upper thoracic regions and are most often intramedullary. Arteriovenous malformations may be small and focal or may occupy up to 50% of the spinal cord. They may compress or even displace normal spinal cord parenchyma, or they may rupture, causing focal or generalized hemorrhage.
Cutaneous angiomas are sometimes located over spinal arteriovenous malformations. Arteriovenous malformations usually compress nerve roots, causing pain radiating downward into the area of innervation of the affected root (radicular pain), or compress the spinal cord, causing segmental neurological deficit, gradually increasing or wave-like. Symptoms of damage to the upper and lower motor neurons are often encountered. Arteriovenous malformations can rupture within the substance of the spinal cord, which causes sudden severe back pain and acute segmental neurological deficit. Arteriovenous malformations of the upper spinal cord rarely cause subarachnoid hemorrhages, manifested by sudden and severe headache, neck stiffness, decreased level of consciousness.
Spinal arteriovenous malformations may be an incidental finding during neuroimaging studies. An arteriovenous malformation may be suspected based on clinical features: unexplained segmental neurologic deficits or subarachnoid hemorrhage, especially in the presence of sudden severe back pain or midline cutaneous angiomas.
Surgical treatment of arteriovenous malformations is indicated if they pose a risk to the spinal cord, but requires good experience in microsurgical technique. Stereotactic radiosurgery is useful for small arteriovenous malformations located in difficult to surgically accessible areas. Angiographic occlusion by embolization of the afferent artery often precedes surgical intervention or stereotactic surgery.
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