BACKGROUND: Spinal dural arteriovenous fistula is an abnormal connection between the arteries and veins surrounding the spinal cord. Symptoms may be vague contributing to its diagnostic difficulty. In some cases, patients may develop lower extremity weakness or sensory deficits, back or leg pain, and bowel or bladder dysfunction.

CASE REPORT: We present a case of a female patient with chronic back pain who underwent routine and elective interlaminar epidural steroid injection and developed symptoms of thoracic cord compression due to a thoracic dural arteriovenous fistula that had not been previously identified on imaging.

CONCLUSIONS: Our case emphasizes the importance of early recognition of symptoms of acute cord compression, as well as close review of magnetic resonance imaging in order to identify subtle changes that may indicate a rare anatomical anomaly that can cause significant disability.

KEYWORDS: Epidural, ateriovenous fistula, cauda equina, spinal cord compression