Pathophysiology and Classification of Spinal Vascular Malformations

Spinal vascular malformations (sVMs), encompassing spinal arteriovenous malformations and fistulas, represent a rare and intricate neurosurgical challenge. Various mechanisms are proposed to elucidate neurological deterioration associated with arteriovenous shunting. These mechanisms include venous hypertension, venous congestion, hemorrhage, vascular steal, or mass effect, which may be exacerbated by the presence of venous varices or aneurysmal dilations. The classification of sVMs depends upon their anatomic location and features. The two widely used classifications are (1) the American/French/English connection and (2) the Spetzler system. Additionally, various classification systems have been delineated throughout the past century.