Is spinal angiography useful in the differential diagnosis of myelopathies of unknown origin? Analysis of a series of 93 patients.

BACKGROUND

Myelopathies of unknown origin (MUO) constitute a challenge for the clinician, due to the absence of image findings that explain the symptoms of the patients. The role of spinal angiography (SA) in MUO has not been studied before in the medical literature.

METHODS

Retrospective study of 93 SA performed in a neurointerventional reference center in a ten-year period (January 2013-December 2022). Suspected, angiopraphic and final diagnosis for each patient were studied and compared.

RESULTS

SA constituted an 0.8% of the total neurointerventional procedures performed (93 out of 10997). Suspected diagnosis were: dural fistula 39 patients (41.9%), vertebral tumours 19 (20.4%), MUO 12 (12.9%), spinal arteriovenous malformation 9 (9.6%), spontaneous epidural hematoma 8 (8.6%), spinal stroke 2 (2.2%), angioma 2 (2.2%), cavernoma 1 (1.1%), y spinal artery aneurism 1 (1.1%). Angiographic diagnoses in patients with MUO were: no abnormal findings in 11 patients (91,7%) and one cervical dural fistula dural (8.3%). Final diagnosis in patients with MUO without abnormal findings in the SA were: spinal muscular atrophy, transverse myelitis, syringomyelia, sciatic neuropathy, chronic back pain, lumbosacral neuropathy, simulated paraplegia, lumbosacral plexopathy, somatoform disorder, autoinmune myelopathy and L4/L5 discal herniation.

CONCLUSIONS

In this series of 93 patients, MUO were the third more frequent indication for SA, only after dural fistula and vertebral tumours. Other indications were spinal arteriovenous malformations, spinal epidural hematomas, cavernomas, spinal artery aneurism and spinal stroke. SA seems to be a useful tool in the management of some cases of MUO.