Spinal vascular malformation, also known as spinal hemangioma, is a congenital developmental abnormality or malformation of spinal blood vessels. The thoracic segment of the spinal cord is most commonly affected, followed by the lumbosacral segment. Some cases may involve the entire length of the spinal cord. Clinically, it can present with sudden pain in the head, neck, or lumbosacral region, as well as incomplete or complete paraplegia or quadriplegia. A characteristic feature of the paraplegia is its stage of remission. The condition is more commonly seen in young and middle-aged individuals. With early diagnosis and radical surgery, many patients can achieve favorable outcomes.

bubble_chart Clinical Manifestations

1. Pain: Early stages often present with transient neuralgia, occasionally severe pain. The pain is stabbing or burning in nature, with the location corresponding to the affected segment. 2. Sensory symptoms: Numbness in the limbs, a crawling sensation, and frequent deep or superficial sensory disturbances in the body. 3. Motor symptoms: Weakness in the limbs, gradually worsening, leading to complete or incomplete paralysis in one or both limbs. 4. Sphincter symptoms: Urinary incontinence. 5. Spontaneous subarachnoid hemorrhage: Sudden headache, paraplegia, neck stiffness, and a positive Kernig's sign.

bubble_chart Diagnosis

1. The onset is insidious, with possible symptom relief during the course of the disease, and partial or complete transverse damage signs below the lesion level. 2. Lumbar puncture reveals varying degrees of subarachnoid space obstruction. The cerebrospinal fluid appears pale yellow or colorless and transparent, with increased protein content and sometimes containing red blood cells. 3. Spinal angiography or myelography with iodized oil can reveal the lesion and its extent. MRI may sometimes show clumped or earthworm-like malformed vascular shadows with flow void effects.

1. Surgical resection. 2. Vascular embolization: This method can be used for cases where surgical resection is difficult. 3. Radiation therapy: May be effective for small vascular malformations. However, the overall efficacy is poor, so it is generally not recommended.

The onset of this disease is usually slow, and it is easily misdiagnosed in the early stages as multiple sclerosis of the spinal cord, spinal arachnoiditis, or intramedullary spinal cord tumors. Without treatment, most patients progress to complete paralysis within 2-3 years. Early diagnosis and prompt surgery before limb paralysis occurs can improve symptoms in 70% of patients, even allowing them to resume work. If young or middle-aged individuals suddenly experience back pain and limb weakness, especially if followed by a spontaneous stage of remission, this disease should be considered, and they should seek immediate hospital examination and treatment.

bubble_chart Cure Criteria

1. Cured: (1) Spinal vascular malformation has basically disappeared; (2) Neurological symptoms have disappeared or significantly improved. 2. Improved: Symptoms of spinal cord dysfunction have shown some recovery. 3. Not cured: (1) Spinal vascular malformation has not disappeared; (2) Neurological symptoms show no improvement.