Spinal Dural Arteriovenous Fistula Supplied by a Lateral Sacral Artery: A Rare Cause of Progressive Myelopathy Following Trauma

Abstract Spinal dural arteriovenous fistulas (AVFs) are rare but treatable causes of progressive myelopathy. Early diagnosis is critical to prevent irreversible neurological deficits. We report a 47-year-old woman who developed progressive bilateral lower limb weakness and sphincter dysfunction following trauma. MRI showed long-segment cord edema with serpiginous flow voids. Digital subtraction angiography identified a spinal dural AVF supplied by a branch of the left lateral sacral artery. Endovascular embolization achieved complete occlusion, with complete neurological and neuropathic pain recovery during 6 months of follow-up. This case underscores the importance of thorough angiography, including sacral feeders, in progressive myelopathy.