Neurofibromatosis type 1 (NF1) is a common autosomal dominant neurocutaneous disorder with multisystem involvement. Although cutaneous and neural manifestations are frequent, vascular complications are relatively rare and often under-recognized. Spinal arteriovenous fistulas (AVFs) are an uncommon but important vascular manifestation of NF1 and may lead to progressive myelopathy due to venous hypertension and cord compression. We report a case of a 30-year-old male soldier presenting with gradually progressive spastic quadriparesis and sensory impairment caused by a cervical vertebral arteriovenous fistula associated with NF1. Successful endovascular embolization resulted in complete obliteration of the fistula and neurological stabilization. This case highlights the importance of early suspicion, detailed neuroimaging, and timely intervention in potentially reversible causes of myelopathy.