Table 2

Knowledge, attitude and practice questionnaire

Items for knowledgeN (%)
CorrectIncorrectUnclear
K1. SVM is a congenital abnormality of cerebrovascular development that can result in acute, subacute or chronic brain dysfunction. (Correct)495 (95.74)6 (1.16)16 (3.09)
K2. After a long course of the disease, patients with SVM develop severe neurological deficits and require neurosurgery. (Correct)474 (91.68)23 (4.45)20 (3.87)
K3. In adolescents, SVM is one of the most common causes of severe disability due to its low incidence, heterogeneity in onset and easy misdiagnosis. (Correct)472 (91.30)16 (3.09)29 (5.61)
K4. There are several types of SVM, including spinal dural arteriovenous fistula, spinal arteriovenous malformation, perimedullary arteriovenous fistula, epidural arteriovenous fistula and cavernous vascular malformation. (Correct)485 (93.81)7 (1.35)25 (4.84)
K5. Spinal angiography is the gold standard for the diagnosis of spinal cord vascular lesions, especially spinal dural arteriovenous fistulas, and arteriovenous malformations. (Correct)496 (95.94)5 (0.97)16 (3.09)
K6. Acute manifestations and long-term progressive neurological decline are the two types of clinical manifestations of SVM. (Correct)472 (91.30)12 (2.32)33 (6.38)
K7. All patients with SVM would experience symptoms of myelopathy, including lower extremity weakness, loss of pain and temperature sensation, and bladder and faecal incontinence. (Incorrect)220 (42.55)245 (47.39)52 (10.06)
K8. Neurogenic claudication is often associated with spinal dural arteriovenous fistulas, worsened by physical activities such as walking and standing and relieved by sitting. (Correct)414 (80.08)38 (7.35)65 (12.57)
K9. Spinal arteriovenous malformation most commonly causes subarachnoid, intraparenchymal or both types of bleeding. (Correct)470 (90.91)16 (3.09)31 (6.00)
K10. Spinal cavernous malformation is not inherited. (Incorrect)216 (41.78)175 (33.85)126 (24.37)
K11. Surgical or endovascular intervention of SVM can be used to stop or reverse disease progression by eliminating blood flow at abnormal fistula junctions and restoring normal spinal cord perfusion and intravascular pressure. (Correct)482 (93.23)4 (0.77)31 (6.00)
K12. Endovascular therapy and diagnostic angiography cannot be performed simultaneously. (Incorrect)141 (27.27)312 (60.35)64 (12.38)
Items for attitudeExtremely positivePositiveNeutralNegativeExtremely negative
A1. Despite its low incidence rate, spinal vascular malformation often leads to severe clinical symptoms and great harm.363 (70.21)141 (27.27)9 (1.74)3 (0.58)1 (0.19)
A2. Due to atypical clinical presentation, many patients with spinal vascular malformations are misdiagnosed and treated inappropriately.306 (59.19)193 (37.33)14 (2.71)3 (0.58)1 (0.19)
A3. The prognosis of spinal dural arteriovenous fistula can be greatly improved by early diagnosis and treatment before permanent spinal cord ischaemic injury occurs.362 (70.02)139 (26.89)14 (2.71)1 (0.19)1 (0.19)
A4. As soon as a spinal vascular malformation is diagnosed, it is imperative to seek timely and effective treatment.373 (72.15)123 (23.79)14 (2.71)6 (1.16)1 (0.19)
A5. Spinal vascular malformations are rare and complex, and I know little about them.140 (27.08)229 (44.29)95 (18.38)41 (7.93)12 (2.32)
A6. I would like to learn more about spinal vascular malformations.317 (61.32)182 (35.20)15 (2.90)2 (0.39)1 (0.19)
Items for practiceExtremely positive/likelyPositive/likelyNeutralNegative/unlikelyExtremely negative/unlikely
Other departments
P1. It is imperative to pay close attention to patients who develop severe low back pain, muscle weakness, and incontinence in a short period of time, and to carry out relevant examinations immediately to confirm the diagnosis.84 (69.42)33 (27.27)4 (3.31)00
P2. I am confident that I can identify spinal vascular malformations and refer patients to a specialist.37 (30.58)40 (33.06)35 (28.93)6 (4.96)3 (2.48)
SVM-related departments
PP1. Are you likely to recommend or take the following actions if you encounter a patient with suspected spinal vascular malformation?
PP1.1 A complete physical examination (mainly the nervous system)308 (77.78)63 (15.91)19 (4.80)5 (1.26)1 (0.25)
PP1.2 Assessment of symptoms (sensation and motor dysfunction, incontinence, severe back pain, etc)310 (78.28)70 (17.68)14 (3.54)02 (0.51)
PP1.3 Spinal cord MRI334 (84.34)43 (10.86)14 (3.54)3 (0.76)2 (0.51)
PP1.4 Spinal cord computed tomographic angiography or magnetic resonance angiography261 (65.91)68 (17.17)46 (11.62)13 (3.28)8 (2.02)
PP1.5 Plain X-rays66 (16.67)55 (13.89)148 (37.37)58 (14.65)69 (17.42)
PP1.6 Spinal cord angiography285 (71.97)60 (15.15)30 (7.58)13 (3.28)8 (2.02)
PP1.7 Lumbar puncture97 (24.49)80 (20.20)124 (31.31)47 (11.97)48 (12.12)
PP2. In clinical practice, are you likely to treat patients diagnosed with the following diseases with the following treatments?
PP2.1 Dural arteriovenous fistula: surgery148 (37.37)92 (23.23)83 (20.96)39 (9.85)34 (8.59)
PP2.2 Spinal arteriovenous malformation: surgery123 (31.06)102 (25.76)98 (24.75)40 (10.10)33 (8.33)
PP2.3 Spinal arteriovenous malformation: embolisation219 (55.30)121 (30.56)29 (7.32)10 (2.53)17 (4.29)
PP2.4 Spinal arteriovenous fistula: embolisation217 (54.80)121 (30.56)33 (8.33)7 (1.77)18 (4.55)
PP2.5 Cavernous malformation: surgery189 (47.73)98 (24.75)66 (16.67)19 (4.80)24 (6.06)
  • Doctors from SVM-related departments (neurosurgery, orthopaedics and neurology) answered 12 questions (PP1.1–PP1.7 and PP2.1–PP2.5) and doctors from other departments answered two questions (P1 and P2).

  • Answers ‘yes’ to PP1 received 1 point, whereas answers ‘no’ received 0 point.

  • With the exception of PP3.2 and PP3.3, all other questions were scored on a 5-point Likert.

  • SVM, spinal vascular malformations.