- Spinal Epidural Arteriovenous Fistula with Perimedullary Venous Reflux: Clinical and Neuroradiologic Features of an Underestimated Vascular Disorder
Thirteen consecutive patients were diagnosed with deep lumbosacral spinal dural arteriovenous fistula at a single center between 2006 and 2018. Paraparesis was present in 12 (92%) patients. Sphincter dysfunction and sensory symptoms were observed in 7 (54%) and 6 (46%) patients, respectively. The mean duration of symptoms was 6 ± 8 months. Congestive myelopathy on MR imaging was present in all patients. Prominent arterialized perimedullary veins were demonstrated in only 3 cases. Time-resolved contrast-enhanced dynamic MRA revealed arterialized perimedullary veins and an arterialized ventrolateral epidural pouch in 9/10 (90%) patients, mostly located ventrolaterally. The authors conclude that time-resolved contrast-enhanced dynamic MRA is a powerful diagnostic tool for identifying arterialized perimedullary veins as well as an arterialized ventrolateral epidural pouch.
- Fluoroscopically Guided Facet Injections: Comparison of Intra-Articular and Periarticular Steroid and Anesthetic Injection on Immediate and Short-Term Pain Relief
The authors evaluated the immediate and short-term efficacy of intra-articular and periarticular steroid/anesthetic injections for facet-mediated lumbar pain. Seventy-seven patients had 100 procedures with 205 total facet joints injected. All intra-articular, all periarticular, and partial peri-/intra-articular injections constituted 54%, 20%, and 26% of the cases, respectively. The immediate and 1-week postprocedural change in pain was -3.7 and -1.4 for the all intra-articular and -3.6 and -1.2 for the combined group. They conclude that the intra-articular and periarticular fluoroscopically guided facet injections provide statistically significant and similar pain relief both immediately and 1 week postinjection.
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