LAUSR

INTRODUCTION Typically, the clinical presentation of spinal dural arteriovenous fistulae (SDAVFs) is insidious and patients' symptoms are regularly attributed to other conditions. Although previous studies have characterized patient neurologic outcomes following treatment for SDAVF, little is known about the pre-intervention patient characteristics associated with poor and/or positive patient outcomes. OBJECTIVES We sought to characterize pre-treatment patient demographics, diagnostic history, and the neurologic outcomes of patients treated for SDAVFs and to identify patient factors that are predictive of these outcomes. METHODS The medical records of patients who had been treated for SDAVFs from 2006 to 2018 across one healthcare system were retrospectively analyzed. Neurological status was assessed both pre- and post-intervention using the Aminoff-Logue scales (ALS) for gait and micturition disturbances. RESULTS Of 46 total patients, 16 patients (35%) had a documented misdiagnosis. Patients' with a history of misdiagnosis had a significantly longer duration of symptoms before treatment compared to those without misdiagnosis (median = 2.3 vs 0.9 years, P = 0.018). A shorter duration of symptoms before intervention was significantly associated with both improved motor function (median = 0.8 vs 3.1 years, P = 0.001) and improved urinary function (median = 0.8 vs 2.2 years, P = 0.040) following intervention. CONCLUSIONS Misdiagnosis is relatively common in patients with SDAVFs and contributes to delays in treatment. Delays in diagnosis and treatment for SDAVFs appear to be associated with worse clinical outcomes in patients who do ultimately receive treatment.