{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:35:35Z","timestamp":1787754935972,"version":"build-2784847793"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JBJS Case Connector"],"published-print":{"date-parts":[[2015,7,8]]},"abstract":"<jats:sec>\n                    <jats:title>Case:<\/jats:title>\n                    <jats:p>Of the many potential causes of nerve compression that lead to radiculopathy, vascular etiologies remain among the most infrequent, with an estimated prevalence of only five to ten per million cases of radiculopathy. In this case report, we outline the clinical presentation, imaging, intraoperative findings, and pathologic findings for a fifty-four-year old patient with an intradural, extramedullary form of a spinal dural arteriovenous fistula at the L1-L2 level who presented only with axial back pain and radiculopathy. The radiologist and surgeon initially diagnosed the patient with a herniated nucleus pulposus. However, the intraoperative findings and angiogram were suggestive of an arteriovenous fistula. Methods to identify this rare entity are described for the orthopaedic spine community.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The potential for a missed diagnosis is particularly important as many partial discectomy procedures are performed at small surgical centers with limited blood products available and no vascular surgeon on staff. For patients with preoperative magnetic resonance imaging (MRI) that is suggestive of vascular malformations (T2 hyperintensity in the lower spinal cord and conus medullaris), we recommend that MR angiography be performed as a secondary diagnostic evaluation. MR angiography has a 95% positive predictive value for specifically diagnosing an arteriovenous fistula.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.cc.m.00284","type":"journal-article","created":{"date-parts":[[2015,7,8]],"date-time":"2015-07-08T22:35:37Z","timestamp":1436394937000},"page":"e59","source":"Crossref","is-referenced-by-count":1,"title":["Spinal Dural Arteriovenous Fistula Presenting as a Recurrent Nucleus Pulposus Herniation"],"prefix":"10.2106","volume":"5","author":[{"given":"Kushagra","family":"Verma","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Thomas Jefferson University, 1025 Walnut Street, Room 516 College, Philadelphia, PA 19107. E-mail address for K. Verma:"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Fennessy","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Thomas Jefferson University, 1025 Walnut Street, Room 516 College, Philadelphia, PA 19107. E-mail address for K. Verma:"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Thomas Jefferson University, 1025 Walnut Street, Room 516 College, Philadelphia, PA 19107. E-mail address for K. Verma:"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Jabbour","sequence":"additional","affiliation":[{"name":"Division of Neurovascular Surgery and Endovascular Neurosurgery, Thomas Jefferson University Hospital, 925 Chestnut Street, Philadelphia, PA 19107"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Rihn","sequence":"additional","affiliation":[{"name":"Orthopedic Spine Surgery, The Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"1","key":"bib1-20231015","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.spinee.2010.09.027","article-title":"Vascular causes of radiculopathy: a literature review","volume":"11","author":"Benny","year":"2011","journal-title":"Spine J."},{"issue":"1","key":"bib2-20231015","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1097\/01.wco.0000200547.22292.11","article-title":"Spinal dural arteriovenous fistula","volume":"19","author":"Koch","year":"2006","journal-title":"Curr Opin Neurol."},{"issue":"6","key":"bib3-20231015","doi-asserted-by":"crossref","first-page":"795","DOI":"10.3171\/jns.1987.67.6.0795","article-title":"Spinal arteriovenous malformations: a comparison of dural arteriovenous fistulas and intradural AVM\u2019s in 81 patients","volume":"67","author":"Rosenblum","year":"1987","journal-title":"J Neurosurg."},{"issue":"7","key":"bib4-20231015","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1007\/s11883-013-0335-7","article-title":"Spinal dural arteriovenous fistulas: a review","volume":"15","author":"Marcus","year":"2013","journal-title":"Curr Atheroscler Rep."},{"issue":"1","key":"bib5-20231015","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.ncl.2012.09.004","article-title":"Vascular diseases of the spinal cord","volume":"31","author":"Rubin","year":"2013","journal-title":"Neurol Clin."},{"issue":"25","key":"bib6-20231015","doi-asserted-by":"crossref","first-page":"E1641","DOI":"10.1097\/BRS.0b013e31821352dd","article-title":"The clinical and radiological presentation of spinal dural arteriovenous fistula","volume":"36","author":"Muralidharan","year":"2011","journal-title":"Spine (Phila Pa 1976)."},{"issue":"5","key":"bib7-20231015","doi-asserted-by":"crossref","first-page":"1350","DOI":"10.1227\/NEU.0b013e3181ef2821","article-title":"Surgical treatment of spinal dural arteriovenous fistulae: a consecutive series of 154 patients","volume":"67","author":"Saladino","year":"2010","journal-title":"Neurosurgery."},{"issue":"3","key":"bib8-20231015","doi-asserted-by":"crossref","first-page":"e19","DOI":"10.4081\/ni.2012.e19","article-title":"A rare case of spinal dural arteriovenous fistula","volume":"4","author":"Apostolova","year":"2012","journal-title":"Neurol Int."},{"issue":"1","key":"bib9-20231015","doi-asserted-by":"crossref","first-page":"E3","DOI":"10.3171\/FOC.2009.26.1.E3","article-title":"Type I spinal dural arteriovenous fistulas: historical review and illustrative case","volume":"26","author":"Klopper","year":"2009","journal-title":"Neurosurg Focus."},{"key":"bib10-20231015","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1007\/BF00344211","article-title":"Spinal epidural angiomatous malformations draining into intrathecal veins","volume":"13","author":"Kendall","year":"1977","journal-title":"Neuroradiology."},{"issue":"2","key":"bib11-20231015","doi-asserted-by":"crossref","first-page":"166","DOI":"10.3171\/jns.1995.82.2.0166","article-title":"A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment","volume":"82","author":"Borden","year":"1995","journal-title":"J Neurosurg."},{"issue":"10","key":"bib12-20231015","first-page":"2029","article-title":"Spinal dural arteriovenous fistulas: evaluation with MR angiography","volume":"16","author":"Bowen","year":"1995","journal-title":"AJNR Am J Neuroradiol."},{"issue":"3","key":"bib13-20231015","first-page":"375","article-title":"Dural arteriovenous fistula and progressive conus medullaris syndrome as complications of lumbar discectomy","volume":"97","author":"Asakuno","year":"2002","journal-title":"Case report. 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