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Study designRetrospective cohort study of prospectively accrued data.ObjectiveTo evaluate a large, prospective, multicentre dataset of surgically treated degenerative cervical myelopathy (DCM) cases on the contemporary risk of C5 palsy with surgical approach.Summary of background dataThe influence of surgical technique on postoperative C5 palsy after decompression for DCM is intensely debated. Comprehensive, covariate-adjusted analyses are needed using contemporary data.MethodsPatients with moderate to severe DCM were prospectively enrolled in the multicenter, randomized, Phase III CSM-Protect clinical trial and underwent either anterior or posterior decompression between Jan 31, 2012 and May 16, 2017. The primary outcome was the incidence of postoperative C5 palsy, defined as the onset of muscle weakness by at least one grade in manual muscle test at the C5 myotome with slight or absent sensory disruption after cervical surgery. Two comparative cohorts were made based on the anterior or posterior surgical approach. Multivariate hierarchical mixed-effects logistic regression was used to estimate odds ratios (OR) with 95% confidence intervals (CI) for C5 palsy.ResultsA total of 283 patients were included, and 53.4% underwent posterior decompression. The total incidence of postoperative C5 palsy was 7.4% and was significantly higher in patients who underwent posterior decompression compared with anterior decompression (11.26% vs. 3.03%, P =0.008). After multivariable regression, the posterior approach was independently associated with greater than four times the likelihood of postoperative C5 palsy ( P =0.017). Rates of C5 palsy recovery were comparable between the two surgical approaches.ConclusionThe odds of postoperative C5 palsy are significantly higher after posterior decompression compared to anterior decompression for DCM. This may influence surgical decision-making when there is equipoise in deciding between anterior and posterior treatment options for DCM.Level of evidenceTherapeutic Level-II.

BACKGROUND: Degenerative cervical myelopathy (DCM) is a progressive chronic spinal cord injury estimated to affect 1 in 50 adults. Without standardised guidance, clinical research studies have selected outcomes at their discretion, often underrepresenting the disease and limiting comparability between studies. Utilising a standard minimum data set formed via multi-stakeholder consensus can address these issues. This combines processes to define a core outcome set (COS)-a list of key outcomes-and core data elements (CDEs), a list of key sampling characteristics required to interpret the outcomes. Further how these outcomes should be measured and/or reported is then defined in a core measurement set (CMS). This can include a recommendation of a standardised time point at which outcome data should be reported. This study defines a COS, CDE, and CMS for DCM research. METHODS AND FINDINGS: A minimum data set was developed using a series of modified Delphi processes. Phase 1 involved the setup of an international DCM stakeholder group. Phase 2 involved the development of a longlist of outcomes, data elements, and formation into domains. Phase 3 prioritised the outcomes and CDEs using a two-stage Delphi process. Phase 4 determined the final DCM minimal data set using a consensus meeting. Using the COS, Phase 5 finalised definitions of the measurement construct for each outcome. In Phase 6, a systematic review of the literature was performed, to scope and define the psychometric properties of measurement tools. Phase 7 used a modified Delphi process to inform the short-listing of candidate measurement tools. The final measurement set was then formed through a consensus meeting (Phase 8). To support implementation, the data set was then integrated into template clinical research forms (CRFs) for use in future clinical trials (Phase 9). In total, 28 outcomes and 6 domains (Pain, Neurological Function, Life Impact, Radiology, Economic Impact, and Adverse Events) were entered into the final COS. Thirty two outcomes and 4 domains (Individual, Disease, Investigation, and Intervention) were entered into the final CDE. Finally, 4 outcome instruments (mJOA, NDI, SF-36v2, and SAVES2) were identified for the CMS, with a recommendation for trials evaluating outcomes after surgery, to include baseline measurement and at 6 months from surgery. CONCLUSIONS: The AO Spine RECODE-DCM has produced a minimum data set for use in DCM clinical trials today. These are available at https://myelopathy.org/minimum-dataset/. While it is anticipated the CDE and COS have strong and durable relevance, it is acknowledged that new measurement tools, alongside an increasing transition to study patients not undergoing surgery, may necessitate updates and adaptation, particularly with respect to the CMS.

Patients with degenerative cervical myelopathy (DCM) experience structural and functional brain reorganization. However, few studies have investigated the influence of sex on cerebral alterations. The present study investigates the role of sex on brain functional connectivity (FC) and global network topology in DCM and healthy controls (HCs). The resting-state functional MRI data was acquired for 100 patients (58 males vs. 42 females). ROI-to-ROI FC and network topological features were characterized for each patient and HC. Group differences in FC and network topological features were examined. Compared to healthy counterparts, DCM males exhibited higher FC between vision-related brain regions, and cerebellum, brainstem, and thalamus, but lower FC between the intracalcarine cortex and frontal and somatosensory cortices, while DCM females demonstrated higher FC between the thalamus and cerebellar and sensorimotor regions, but lower FC between sensorimotor and visual regions. DCM males displayed higher FC within the cerebellum and between the posterior cingulate cortex (PCC) and vision-related regions, while DCM females displayed higher FC between frontal regions and the PCC, cerebellum, and visual regions. Additionally, DCM males displayed significantly greater intra-network connectivity and efficiency compared to healthy counterparts. Results from the present study imply sex-specific supraspinal functional alterations occur in patients with DCM.

Objective: This study aimed to evaluate the medium-term outcome following spinal cord decompression and instrumented fixation of single-level congenital thoracolumbar vertebral malformations, characterized by combined failures of segmentation and formation, causing thoracolumbar myelopathy in three large-breed dogs. Study design: This was a retrospective clinical study. Animals: The animals involved in the study were three large-breed dogs. Methods: Electronic patient records were retrospectively reviewed for adult large-breed dogs (>1 year) (>25 kg) with thoracolumbar myelopathy and a radiologic diagnosis of spinal cord compression associated with thoracolumbar vertebral malformation. The examination, diagnostic imaging, surgical management, and outcomes are described. The medium-term outcome was determined based on the neurological examination and follow-up imaging studies conducted up to 12 months post-operation. Results: Three large-breed dogs were identified, presenting with progressive, non-painful T3–L3 spinal cord segment disease. Diagnosis was made using MRI and CT, which revealed single-level complex congenital vertebral malformation with combined failures of segmentation and formation in the T8–L1 region. Surgical management consisted of ventral cord decompression by bilateral mini-hemilaminectomy and partial corpectomy and vertebral fixation. Temporary postoperative neurological deterioration was observed in two cases. Follow-up was conducted at 6 weeks (examination) and 3 (examination), 6, and 12 months (examination and CT) postoperatively, and improved neurological function was confirmed, with all cases being ambulatory with persistent, mild paraparesis. Conclusion: This retrospective study demonstrates the successful medium-term outcome following surgical management of complex thoracolumbar vertebral malformations in large-breed dogs. [ABSTRACT FROM AUTHOR]

Simple Summary: Respiratory integrity of dogs under general anaesthesia results from the seamless contraction of the main respiratory muscle, the diaphragm, which is innervated by the phrenic nerve, which originates from the fifth, sixth, and seventh cervical segments. Diaphragmatic contractility can be assessed by transdiaphragmatic pressure measurement, a reliable method in dogs. Respiratory distress in dogs suffering from cervical focal myelopathy is reported in the veterinary literature, but it is unknown whether cervical focal myelopathy results in diaphragmatic contractility impairment. The aim of this study is to quantify transdiaphragmatic pressure in dogs under isoflurane anaesthesia affected by cervical myelopathy, compare the results with dogs affected by thoracolumbar myelopathy, and determine whether focal spinal disorders affect respiratory function. There appears to be a diaphragmatic contractility impairment in both cervical and thoracolumbar myelopathy, since there is a similar reduction of the transdiaphragmatic pressure in both conditions. These results could improve the quality, treatment strategies, and monitoring offered by anaesthesiologists and clinicians treating dogs suffering from focal myelopathies in the cervical and thoracolumbar spinal cord. Background: The purpose of this study is to evaluate differences in transdiaphragmatic pressure (Pdi) in dogs suffering from cervical myelopathy (CM) and thoracolumbar myelopathy (TLM) anaesthetised with isoflurane (ISO). Methods: This prospective cohort study included ASA II-status dogs diagnosed with either CM or TLM, anaesthetised for diagnostic or surgical purposes between September 2021 and July 2023. Patients followed the same anaesthetic protocol, and maximum Pdi was recorded at 10 (Pdimax10), 20 (Pdimax20), and 30 (Pdimax30) minutes using balloon catheters placed in the stomach (Pgast) and in the mid-third of the oesophagus (Poes). Results: A total of 50 dogs were included: 25 in the CM group and 25 in the TLM group. In the TLM group, Pdimax10 was 9.4 mmHg ± 6.1, and in the CM group, it was 7.2 mmHg ± 4.6 (p = 0.167). Pdimax20 was 10.2 mmHg ± 5.8 in the TLM group and 8 mmHg ± 5.1 in the CM group (p = 0.155). Pdimax30 was 9.2 mmHg ± 5.5 in the TLM group and 8.1 mmHg ± 5.5 in the CM group (p = 0.479). Conclusions: The findings suggest that diaphragmatic contractility is similar in dogs with CM and TLM under ISO anaesthesia. [ABSTRACT FROM AUTHOR]

The article in Neurology India discusses the use of intraoperative indocyanine green (ICG) fluorescence imaging in identifying arterial feeders of spinal schwannomas during surgery. The study demonstrates that by resecting the feeder first, minimal bleeding occurs, facilitating the removal of the tumor. Two cases are presented, showing successful tumor removal with minimal bleeding using this technique. The article highlights the importance of ICG imaging in reducing bleeding during spinal schwannoma surgery, enhancing safe resection outcomes. [Extracted from the article]

Background and Objectives: HTLV-1-associated myelopathy (HAM) is a chronic progressive inflammatory disease of the spinal cord. This study assesses the diagnostic accuracy of the neuroinflammatory biomarkers neopterin and cysteine-X-cysteine motif chemokine ligand 10 (CXCL-10) in cerebrospinal fluid (CSF) for HAM. Methods: CSF samples from 75 patients with neurological disorders—33 with HAM (Group A), 19 HTLV-1-seronegative with other neuroinflammatory diseases (Group B), and 23 HTLV-1-seronegative with non-neuroinflammatory diseases (Group C)—were retrospectively evaluated. CSF examination included routine analysis, neopterin, and CXCL-10. The diagnostic potential of the biomarkers was evaluated using receiver operating characteristic curves. Results: Higher white cell counts and concentrations of protein, neopterin, and CXCL-10 in CSF were detected in group A (patients with HAM) and group B (p < 0.05). Neopterin showed good accuracy for HAM (A) (cut-off 15 nmol/L, 80% sensitivity, 74% specificity) and other neuroinflammation (group B) (cut-off 20 nmol/L, 79% sensitivity, 83% specificity). CXCL-10 demonstrated the highest accuracy in both groups, with Group A (cut-off 110 pg/mL, 97% sensitivity, 96% specificity) and Group B (cut-off 220 pg/mL, 100% sensitivity, 100% specificity). Conclusions: Neopterin and CXCL-10 in CSF are accurate biomarkers for detecting neuroinflammation, including HAM. CXCL-10, in particular, is the superior biomarker for both chronic and acute neuroinflammatory diseases. [ABSTRACT FROM AUTHOR]

Study Design: Systematic review. Objective: Degenerative cervical myelopathy (DCM) is a common spinal cord disorder necessitating surgery. We aim to explore how effectively diffusion tensor imaging (DTI) can distinguish DCM from healthy individuals and assess the relationship between DTI metrics and symptom severity. Methods: We included studies with adult DCM patients who had not undergone decompressive surgery and implemented correlation analyses between DTI parameters and severity, or compared healthy controls and DCM patients. Results: 57 studies were included in our meta-analysis. At the maximal compression (MC) level, fractional anisotropy (FA) exhibited lower values in DCM patients, while apparent diffusion coefficient (ADC), mean diffusivity (MD), and radial diffusivity (RD) were notably higher in the DCM group. Moreover, our investigation into the diagnostic utility of DTI parameters disclosed high sensitivity, specificity, and area under the curve values for FA (.84,.80,.83 respectively) and ADC (.74,.84,.88 respectively). Additionally, we explored the correlation between DTI parameters and myelopathy severity, revealing a significant correlation of FA (.53, 95% CI:0.40 to.65) at MC level with JOA/mJOA scores. Conclusion: Current guidelines for DCM suggest decompressive surgery for both mild and severe cases. However, they lack clear recommendations on which mild DCM patients might benefit from conservative treatment vs immediate surgery. ADC's role here could be pivotal, potentially differentiating between healthy individuals and DCM. While it may not correlate with symptom severity, it might predict surgical outcomes, making it a valuable imaging biomarker for clearer management decisions in mild DCM. [ABSTRACT FROM AUTHOR]

Study design: Retrospective, cohort study Objectives: Hand function can be difficult to objectively assess perioperatively. In patients undergoing cervical spine surgery by a single-surgeon, we sought to: (1) use a hand dynamometer to report pre/postoperative grip strength, (2) distinguish grip strength changes in patients with radiculopathy-only vs myelopathy, and (3) assess predictors of grip strength improvement. Methods: Demographic and operative data were collected for patients who underwent surgery 2015-2018. Hand dynamometer readings were pre/postoperatively at three follow-up time periods (0-3 m, 3-6 m, 6-12 m). Results: 262 patients (mean age of 59 ± 14 years; 37% female) underwent the following operations: ACDF (80%), corpectomy (25%), laminoplasty (19%), and posterior cervical fusion (7%), with 81 (31%) patients undergoing multiple operations in a single anesthetic setting. Radiculopathy-only was seen in 128 (49%) patients, and myelopathy was seen 134 (51%) patients. 110 (42%) had improved grip strength by ≥10-lbs, including 69/128 (54%) in the radiculopathy-only group, and 41/134 (31%) in the myelopathy group. Those most likely to improve grip strength were patients undergoing ACDF (OR 2.53, P =.005). Patients less likely to improve grip strength were older (OR =.97, P =.003) and underwent laminoplasty (OR =.44, 95% CI.23,.85, P =.014). Patients undergoing surgery at the C2/3-C5/6 levels and C6/7-T1/2 levels both experienced improvement during the 0-3-month time range (C2-5: P =.035, C6-T2: P =.015), but only lower cervical patients experienced improvement in the 3-6-month interval (P =.030). Conclusions: Grip strength significantly improved in 42% of patients. Patients with radiculopathy were more likely to improve than those with myelopathy. Patients undergoing surgery from the C2/3-C5/6 levels and the C6/7-T1/2 levels both significantly improved grip strength at 3-month postoperatively. [ABSTRACT FROM AUTHOR]

Background: Human immunodeficiency virus (HIV) is a retrovirus mainly infecting immune cells. Central nervous system diseases in HIV-infected patients can be caused by HIV or opportunistic infections. Neurological diseases associated with HIV have diverse manifestations and may occur in early or late stages. This article reports an HIV patient with myelopathy as initial symptom and negative spinal cord magnetic resonance imaging (MRI) and reviews common classifications of HIV-related spinal cord diseases. Case presentation: A 50-year-old male presented with weakness in both lower limbs and gait disorders for more than three months. Physical examination and various tests ruled out many possible causes. Given positive HIV and syphilis antibody in serological examination, normal spinal cord MRI and electromyogram, and after excluding other potential diagnoses through comprehensive analysis, the diagnosis of HIV-related myelopathy was established. Conclusions: Spinal cord lesions caused by HIV infection involve multiple aspects in terms of etiology and mechanism. HIV infection-related vacuolar myelopathy (HIV-VM) is the most common and typical spinal cord lesion. It usually appears at a relatively late stage of HIV infection, but it may also occur in the early stage and even serve as the initial manifestation of newly diagnosed HIV. The diagnosis of HIV myelopathy is usually exclusionary. In imaging, it often shows high T2 signal and spinal cord atrophy on spinal cord MRI, or it may also appear normal. Clinical Trial: Not applicable. [ABSTRACT FROM AUTHOR]

Background: Activity-based therapy (ABT) has shown promise as a viable therapeutic intervention to promote neurorecovery in people with spinal cord injury/disease (SCI/D). Tools that track the details of ABT sessions may facilitate the collection of data needed to inform best practice guidelines for ABT. Objective: The purpose of this study was to evaluate the content validity of a prototype ABT tracking tool. Methods: Nine clinicians and five individuals with SCI/D from three community-based ABT clinics in Canada used the prototype tracking tool over three ABT sessions and then participated in individual cognitive debriefing interviews. The interview guide was developed based on recommendations by Brod and colleagues for establishing content validity (i.e., appropriate, comprehensive, comprehensibility). Interviews were transcribed verbatim and analysed using deductive followed by inductive content analysis. Results: Overall, the ABT tracking tool was found to have good content validity. Identified categories included: (1) Content validity of the ABT tracking tool. Participants found the tool to be comprehensive and appropriate for all levels and severities of injury. Recommendations to improve the tool included adding a comment section and additional parameters to each activity. (2) Facilitators of tool use, dissemination and implementation. Using the tool during rest breaks or after the session were suggested to maximize therapy time. Providing the tool as an app and offering education and training on use of the tool were highly recommended. Advertising through community clinics and social media may facilitate dissemination of the tool. (3) Barriers of tool use, dissemination and implementation. The paper format of the tool, added workload, learning curve and challenge to adopt a new documentation system were considered barriers to tool use. Conclusions: The prototype ABT tracking tool was validated for content using cognitive debriefing interviews. Recommendations will be used to improve the tool and assist in dissemination and implementation efforts. [ABSTRACT FROM AUTHOR]

Background/Objectives: Thermotherapy is expected to assist in the prevention of arteriosclerosis and cardiovascular disease in individuals with spinal cord injuries. This study aimed to investigate the impact and underlying mechanisms of whole-body heat stress on cardiac function in patients with cervical spinal cord injury (CSCI) and healthy controls using head-out hot water immersion (HHWI). Methods: Eight male patients with complete motor CSCI and nine healthy controls were recruited. Participants were immersed for 60 min in water set at 2 °C above the resting esophageal temperature. Esophageal temperature, heart rate, and arterial pressure were monitored throughout the experiment. Before and after HHWI, echocardiography was used to measure indices of left ventricular diastolic capacity (E, E′, and A), left atrial contractility (A and A′), and left ventricular contractility [S′ and isovolumic acceleration (IVA)]. Results: Both groups exhibited an increase in body temperature and heart rate, while blood pressure remained stable. In the control group, there was a significant increase in E (67.0 ± 22.6 to 89.1 ± 13.6), E′ (9.5 ± 3.8 to 15.1 ± 4.1), A (50.0 ± 15.2 to 75.8 ± 18.2), A′ (8.1 ± 1.6 to 14.8 ± 5.9), S′ (8.7 ± 1.4 to 15.1 ± 4.5) and isovolumic acceleration (IVA) (104.2 ± 14.7 to 151.1 ± 20.6). In the CSCI group, only A (49.5 ± 9.9 to 56.9 ± 10.9) and IVA (94.4 ± 27.2 to 134.7 ± 27.7) showed a significant change. Conclusions: In the control group, heat stress increased left atrial contractility, left ventricular dilatation, and left ventricular contractility, while in patients with CSCI, left atrial contractility and left ventricular contractility improved, but there was no improvement in left ventricular diastolic function. This discrepancy in the impact of HHWI on cardiac function suggests that the sympathetic nervous system predominantly influences left ventricular dilatation during whole-body heat stress. However, other factors may also contribute to left atrial and ventricular contractility. [ABSTRACT FROM AUTHOR]

Our study investigated the therapeutic potential of OKN-007 in the SOD1 G93A mouse model of amyotrophic lateral sclerosis (ALS). The impact of OKN-007, known for its antioxidant, anti-inflammatory, and neuroprotective properties, was tested at two doses (150 mg/kg and 300 mg/kg) at onset and late-stage disease. Results demonstrated a significant delay in disease progression at both doses, with treated mice showing a slower advance to early disease stages compared to untreated controls. Motor neuron counts in the lumbar spinal cord were notably higher in OKN-007 treated mice at the time of disease onset, suggesting neuroprotection. Additionally, OKN-007 reduced microglial activation and preserved reduced neuromuscular junction fragmentation, although it did not significantly alter the increase in astrocyte number or the decline in hindlimb muscle mass. MR spectroscopy (MRS) revealed improved spinal cord perfusion and normalized myo-inositol levels in treated mice, supporting reduced neuroinflammation. While the expression of several proteins associated with inflammation is increased in spinal cord extracts from G93A mice, OKN-007 dampened the expression of IL-1β, IL-1ra and IL-1α. Despite its promising effects on early-stage disease progression, in general, the beneficial effects of OKN-007 diminished over longer treatment durations. Further, we found no improvement in muscle atrophy or weakness phenotypes in OKN-007 treated G93A mice, and no effect on mitochondrial function or lifespan. Overall, our findings suggest that OKN-007 holds potential as a disease-modifying treatment for ALS, although further research is needed to optimize dosing regimens and understand its long-term effects. [ABSTRACT FROM AUTHOR]

Background and purpose: Bacterial meningitis is a severe disease with high rates of complications and unfavorable outcome. Complications involving the spinal cord are rarely reported. Methods: Cases of noncompressive myelopathy were identified from a nationwide cohort study of adults with community‐acquired bacterial meningitis in the Netherlands. The American Spinal Injury Association Impairment Scale was used to classify the severity of spinal cord dysfunction. Subsequently, we reviewed the literature on noncompressive myelopathy as a complication of bacterial meningitis. Results: Noncompressive myelopathy was reported in seven of 3047 episodes of community‐acquired bacterial meningitis (0.2%). The median age of these patients was 51 years (range = 17–77). Causative pathogens were Streptococcus pneumoniae in three, Streptococcus agalactiae in two, and Neisseria meningitidis and Haemophilus influenzae both in one. Paresis of legs (n = 6) or arms and legs (n = 1) was the presenting symptom, occurring after a median duration of 9 days after admission (range = 2–28). Spinal magnetic resonance imaging showed T2‐weighted abnormalities of the spinal cord in six of seven patients. Improvement of spinal cord function during admission was noted in four of seven patients. The literature review yielded 15 additional cases. Among patients from our cohort and the literature, there was no significant association between immunosuppressive therapy and subsequent improvement of spinal cord function (5/8 patients with immunosuppressive therapy [63%] vs. 5/14 without immunosuppressive therapy [36%], p = 0.44). Conclusions: Noncompressive myelopathy is an uncommon but severe complication of bacterial meningitis. Improvement after diagnosis is expected, but all patients had persistent neurological deficits. [ABSTRACT FROM AUTHOR]

Background: Oral health management has become increasingly important for acute inpatients. Older patients often require extended periods of medical care, and oral health management is necessary in the convalescent period following the acute period. During the convalescent period, oral health management remains unclear as convalescent hospitals have limited dental resources, and effective dental care must be provided if the objective of hospitalization is to improve life functions. This study aimed to clarify the relationship between daily functioning and oral health status at the time of admission to a convalescent hospital to aid in improving daily functioning in the convalescent period. Methods: We included patients admitted to the rehabilitation department of a specific convalescent hospital from January to December 2021. A total of 375 patients were included in the study, with complete data records. At admission, we gathered information from the medical records, including the patient's age, sex, primary disease, Charlson Comorbidity Index, Mini Nutritional Assessment Short-Form (MNA-SF), Functional Oral Intake Scale (FOIS), Functional Independence Measure (FIM), number of teeth, and Oral Health Assessment Tool (OHAT). Statistical analysis was conducted using SPSS Ver. 27, with a significance level of 5%. Results: The mean age of the 375 participants (189 men and 186 women) was 75.0 ± 12.1 years (range, 42–97 years), and over 80% were > 65 years. About 30% of major diseases could be attributed to strokes and fractures, followed by spinal cord and spine diseases. In non-stroke patients, multiple regression analysis using FIM motor, FIM cognitive, and FIM and OHAT total scores as objective variables showed that higher total scores of MNA-SF, FOIS, and lower modified Rankin Scale and OHAT were significantly associated with better FIMs. Lower OHAT scores were significantly associated with lower FOIS and MNA-SF scores, male sex, having fewer teeth, and poor dietary patterns. Conclusions: The convalescent period is an opportune time to provide intensive dental care due to the generally stable condition and extended hospital stay. Our results suggest that oral health management, such as dysphagia rehabilitation and denture treatment, is important for maintaining and improving independence, a key objective of convalescent rehabilitation, and malnutrition improvement. [ABSTRACT FROM AUTHOR]

Objective To review and analyze the clinical and imaging characteristics as well as the prognosis of patients with spinal dural arteriovenous fistula (SDAVF), in order to provide reference for the clinical diagnosis and treatment of SDAVF patients. Methods and Results A total of 17 patients with SDAVF diagnosed and treated at Tianjin Huanhu Hospital from May 2019 to January 2024 were included in this study. Among them, 15 patients presented with motor dysfunction, sensory impairment and autonomic dysfunction, while 2 patients presented with spontaneous subarachnoid hemorrhage. The lesions were located in thoracic vertebra in 12 cases, cervical vertebra in 3 cases, and lumbosacral vertebra in 2 cases. All patients underwent surgical resection of the SDAVF, and the operations were successfully completed. The follow-up time was (29.85 ± 19.09) months. At 7 d after surgery, the spinal cord function improved in 10 cases (including improvement in gait scores in 6 cases, bowel and bladder scores in one case, and both in 3 cases), while no improvement was observed in 7 cases. At the final follow-up, spinal cord function improved in 13 cases (including improvement in gait scores in 8 cases, and gait and bowel and bladder scores in 5 cases), while no improvement was observed in 4 cases. No recurrence was observed during the follow -up period. Conclusions SDAVF predominantly occur in the thoracolumbar region of the spinal cord, with progressive symptoms mainly manifesting as motor dysfunction, sensory impairment and sphincter dysfunction. A small proportion of cases initially present with subarachnoid hemorrhage. The failure rate of surgical treatment is low, and the outcomes are significant. Early diagnosis can improve prognosis. [ABSTRACT FROM AUTHOR]