The discovery of a multilevel arteriovenous malformation (AVM) in the thoracic epidural space can now bring relief to potentially thousands of suffers of chronic thoracic pain and progressive myelopothy.
Identified as thoracic epidural arteriovenous malformation (T.E.A.M.), this particular AMV primarily affects younger women ages 20 to 40.
While AVMs are rare, (They affect approximately 300,000 people, according to the National Institutes of Health) AVMs in this particular multilevel location have previously not been documented in medical literature. Symptoms of this condition include severe pain in the middle back area extending to the chest, loss of function and coordination of the lower extremities, hyperreflexia, muscle spasms and severe pain at night.
The discovery was made by neurological spine surgeon Robert S Bray Jr., the CEO and founder of D.I.S.C. Sports and Spine Center. He presented his initial findings at the annual Congress of Neurological Surgeons in New Orleans on Oct. 24-29, 2009.
Undiagnosed, patients are left without viable treatment options that can result in chronic pain, permanent nerve damage and even paralysis of the lower extremities. Corrective action can now be taken with an outpatient microsurgical procedure (laminotomy) that takes approximately one and half to three hours. By clipping the malformation, the pulsing blood flow to the epidural space is interrupted, thus reducing the pressure on the spine.
Following surgery, significant reversal of symptoms and reduction of pain has been documented in all the cases reported, with recovery varying from two months to one year, based on the extent of the disease’s progression.
“The discovery of this new syndrome will help alleviate the needless suffering of patients, especially young women, who are struggling with chronic back pain and neurologic deficits that have previously been undiagnosed or have been completely missed diagnosed,” said Bray, one of the first neurosurgeons in the country to dedicate his practice to minimally invasive spine procedures 20 years ago. “With micro surgical techniques, we are able to remove the malformation and help patients regain an active lifestyle. In the past two years, we have identified 10 patients with this disease, which is quite a high number for any practice, leading me to believe there are potentially thousands affected that can be helped.”
All 10 patients were female. Five have undergone surgery that has led to a reversal of their neurologic deficits and improvement or total resolution of their pain syndromes. The other five are being monitored and have not required surgery. Bray and D.I.S.C. are currently in the process of collecting the data on these patients with long-term follow-ups for future peer-reviewed publications.
The difficulty of the diagnosis was the inability of the AVM to show up on a traditional MRI. The impetus that led to the discovery was a surgical procedure on a young woman to remove a lipoma, which is generally benign fatty tissue. Upon visual inspection, an AVM was discovered and confirmed through pathological studies. Collaborating with Rachael Gordon of Mink Radiology, a specially-designed sequencing scan consisting of gadolinium dye was developed that clearly identifies the malformation.
Source: DISC Sports and Spine Center