# Lower Back Pain Beyond Routine Causes: Sacral Spinal Epidural Arteriovenous Fistula (SEDAVF)

## TL;DR

A rare case of severe lower back pain in a young man was caused by a sacral spinal epidural arteriovenous fistula, successfully treated with endovascular embolization.

## Contribution

This paper presents a rare and complex case of SEDAVF as an unusual cause of lower back pain in a young patient.

## Key findings

- A 32-year-old man presented with severe backache, urinary retention, and constipation due to SEDAVF.
- Contrast-enhanced MRI and digital subtraction angiography confirmed the rare diagnosis of SEDAVF.
- Endovascular embolization successfully treated the patient's condition.

## Abstract

Lower back pain (LBP) is a frequent complaint, even among young people. The most common cause is attributed to slipped discs or vertebral fractures. Less common etiologies should also be considered when presenting with typical symptoms of severe backache. Here, we are presenting one such uncommon case. A 32-year-old man with a history of meningocele repair in neonates presented with severe backache, urinary retention, and constipation in an emergency. Initially, the patient was treated elsewhere, but symptoms persisted. A contrast-enhanced MRI done in the emergency revealed a rare sacral spinal epidural arteriovenous fistula (SEDAVF) with cord congestion. The patient was taken up for digital subtraction angiography, which confirmed the diagnosis, and was treated successfully with endovascular embolization. This case highlights the complex presentation of SEDAVF and the importance of prompt diagnosis and intervention.