The spinal dural arteriovenous fistula is the most common spinal vascular malformation, and it is severely underdiagnosed. The symptoms can mimic those of spinal stenosis. Today, the diagnosis is made by an advantageous combination of MR time-resolved imaging of contrast kinetics and digital subtraction angiography posing low risk to the patient. Treatment is primarily direct microsurgical obliteration. Early treatment is essential, since outcome is dependent on preoperative clinical status.