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Spinal Digital Subtraction Angiography Best Bet for Vascular Spinal Cord Diagnoses

Very low risk of neurologic and systemic complications

Spinal digital subtraction angiography (SpDSA) should remain the gold standard for diagnosis of spinal cord vascular disorders, according to a study published recently in Neurology.

Diagnosing spinal cord-related diseases is a challenge because of nonspecific clinical symptoms and the limitations associated with noninvasive imaging modalities. The authors of the current study sought to investigate the safety of the current gold standard, SpDSA, because of its poor reputation and the lack of contemporary data. They retrospectively reviewed 302 spinal angiograms performed between January 2000 and December 2010 (on 288 patients) at Johns Hopkins Hospital. Each angiogram that was included for analysis covered all the intersegmental arteries or investigated more than four vertebral levels including the artery of Adamkiewicz. Angiograms performed as part of a therapeutic intervention, those combined with a complete four-vessel cerebral angiogram, and those performed intraoperatively, were excluded.

No intraprocedural or postprocedural neurologic complications were found. Two patients experienced systemic complications -- one had back spasms and one had pulmonary edema -- but both recovered quickly. Most cases were performed without general anesthesia. The authors write that advancements in imaging equipment and endovascular devices have contributed to more efficient SpDSA procedures and that their research confirms the limitations of magnetic resonance imaging in this area. They conclude that SpDSA can be performed with a minimal rate of complications, and that it offers “a gold-standard level of diagnostic confidence for the evaluation of the normal and pathologic vasculature of the spinal cord.”

Source: Chen J, Gailloud P. 2011. Safety of spinal angiography: complication rate analysis in 302 diagnostic angiograms. Neurology 77:1235-1240.