Functional Recovery From Prolonged Severe Paraparesis in Patients With Spinal Dural Arteriovenous Fistula: A Report of Two Cases.

A spinal dural arteriovenous fistula (sdAVF) is a rare spinal vascular condition often associated with delayed diagnosis and progressive myelopathy. Long disease duration and severe motor deficits before treatment initiation are generally associated with poor functional outcomes. We report two cases of sdAVF in patients presenting with prolonged symptom duration and severe lower limb paralysis. Despite these unfavourable prognostic indicators, both patients underwent early postoperative rehabilitation aimed at activating the central pattern generator through intensive weight-bearing exercises following surgical treatment. In Case 1, where concomitant spinal degenerative disease was not present, the patient achieved rapid functional improvement and independent ambulation within one week. In contrast, in Case 2, which was complicated by spinal stenosis, ossification of the posterior longitudinal ligament, and poor obliteration of the abnormal vasculature, the patient demonstrated delayed but steady functional gains, ultimately achieving ambulation with minimal assistance at 13 months postoperatively. These cases suggest that even in patients with sdAVF presenting with long-standing symptoms and severe paralysis, functional recovery is possible with tailored rehabilitation. Complications such as spinal degenerative disorders and incomplete obliteration of the abnormal vasculature may affect the rate and degree of recovery. Early and sustained rehabilitation is essential for managing such high-risk patients.