Steroid-Associated Acute Clinical Worsening and Poor Outcome in Patients With Spinal Dural Arteriovenous Fistulas: A Prospective Cohort Study.

Abstract

STUDY DESIGN:

A prospective cohort study.

OBJECTIVE:

We conducted a prospective cohort study to identify the association between steroids and clinical worsening and compare outcomes between patients with and without preoperative steroid administration.

SUMMARY OF BACKGROUND DATA:

Patients with spinal dural arteriovenous fistulas (SDAVFs) often were misdiagnosed and treated with steroids which led to acute worsening.

METHODS:

Patients with angiographically confirmed SDAVFs were recruited consecutively between March 2013 and December 2014 in two referral centers. We reviewed the history of all the patients to identify those patients who were treated with steroids before exclusion of the fistulas. Modified Aminoff & Logue scale (mALS) was used to evaluate the spinal cord function at different time points: before and after steroid administration, before operation, and at 1-year follow-up. Paired t tests were used to assess the mALS of patients with steroid administration at different time points. Unpaired t tests and Pearson chi-square test were used to assess differences between patients with and without steroid administration.

RESULTS:

Eighteen patients with (18.2%) and 81 patients without (81.8%) steroid administration were included in this study. At baseline, there were no difference between both patient groups, in regards to age, sex, duration, location of fistula, treatment, and preoperative mALS. Patients without steroid administration, however, had statistically significant better outcome according to their mALS at 1-year follow-up (P < 0.05).

CONCLUSION:

Steroid administration can induce acute clinical worsening in patients with SDAVFs that may persist despite successful obliteration of the fistula and should thus be avoided.

LEVEL OF EVIDENCE:

3.

• Authors: Yongjie Ma, Tao Hong, Sichang Chen, Chao Peng, Chunxiu Wang, Kun Yang, Jiaxing Yu, Jian Ren, Lisong Bian, Jiang Liu, Zhichao Wang, Timo Krings, Feng Ling, Hongqi Zhang
• Journal: Spine (Spine (Phila Pa 1976)) Vol. 45 Issue 11 Pg. E656-E662 (Jun 01 2020) ISSN: 1528-1159 [Electronic] United States
• PMID: 31923124 (Publication Type: Journal Article, Multicenter Study)

Chemical References

• Steroids

Topics

• Adult
• Aged
• Angiography (trends)
• Central Nervous System Vascular Malformations (diagnostic imaging, drug therapy, physiopathology)
• Cohort Studies
• Disease Progression
• Female
• Humans
• Longitudinal Studies
• Male
• Middle Aged
• Prospective Studies
• Retrospective Studies
• Spinal Cord (diagnostic imaging, drug effects, physiopathology)
• Steroids (adverse effects)
• Treatment Outcome