Year: 2026 | Month: November | Volume: 13 | Issue: 11 | Pages: 92-96
DOI: https://doi.org/10.52403/ijrr.20261108
Spinal Dural AVF Mimicking Degenarative Disc Herniation: Tips and Strategy
Ian Adrianto Limansyah1, Made Satriya Ranuwibawa1, Kadek Dede Frisky Wiyanjana1, Tjokorda Gde Bagus Mahadewa1
1Neurosurgery Division, Surgery Department, Faculty of Medicine, Universitas Udayana, Ngoerah Hospital, Bali, Indonesia
Corresponding Author: Ian Adrianto Limansyah
ABSTRACT
Introduction: Spinal dural arteriovenous fistula is a rare vascular disorder of uncertain etiology and represents the most common spinal vascular malformation, accounting for approximately 60–80% of cases. Its clinical manifestations and radiological findings are often nonspecific, leading to frequent misdiagnosis as degenerative spinal disease or demyelinating disorders. This article describe case of spinal dural arteriovenous fistula that initially mimicked lumbar disc herniation and was unexpectedly identified during surgery.
Case Description: A 65-year-old man presented to the outpatient clinic, with pain in right thigh radiating to right leg. He had experienced chronic low back pain for five years, which had progressively worsened over the preceding four months. Initially, symptoms improved with rest and analgesics, including tramadol and codeine. However, during the last two months, neither medication nor physiotherapy provided relief. Lumbosacral MRI revealed herniated nucleus pulposus at L1-L2, L2-L3, and L4-L5, with associated spinal canal stenosis. Electroneuromyography showed L4-L5 nerve root compression. Based on these findings, decompressive laminectomy with fusion and stabilization from L3-L5 was planned. Intraoperatively, a vascular mass with active bleeding was discovered near the dura mater at L3-L4. After hemostatic control, the lesion was suspected to be an SDAVF and sent for histopathological examination. Pathology demonstrated fibrocollagenous tissue, adipose tissue, and abnormal blood vessels, confirming the diagnosis. Postoperatively, the patient experienced significant pain relief and remained symptom-free during follow-up.
Conclusion: Although rare, Spinal dural arteriovenous fistula can mimic lumbar disc herniation. Careful preoperative assessment and planning for unexpected intraoperative findings are essential for optimal management.
Keywords: Herniated Nucleus Pulposus, Dural arteriovenous fistula
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