Amyloidosis-related cauda equina compression in long-term hemodialysis patients. Three case reports.
METHODS
These case reports illustrate the neurologic manifestations due to beta 2 microglobulin amyloid deposition at the lumbar spine level in long-term hemodialysis patients.


OBJECTIVE
Radiologic investigations suggested the amyloid origin of extradural soft tissue deposition, which was confirmed by histologic examination after surgical excision.


BACKGROUND
Although cervical myelopathy is a recently recognized complication of long-term dialysis-related beta 2 microglobulin amyloidosis, neurologic manifestations due to amyloid deposition at the lumbar spine level have rarely been reported.


METHODS
Three case reports of cauda equina compression in long-term hemodialysis patients are presented. Follow-up radiography, computed tomography, and magnetic resonance imaging were performed and patients underwent surgical decompression of the thecal sac.


RESULTS
In two patients, the compression resulted from the development of a destructive spondylarthropathy, and from the infiltration of extradural spaces and ligaments by an abnormal soft tissue. The third patient had lumbar spinal stenosis due to multiple disc protrusion and to hypertrophy of facet joints and ligamentum flavum. Multilevel laminectomies enabled excision of an abnormal fibrous tissue responsible for the thecal sac compression. Histologic examination of the excised fibrous tissues disclosed amyloid deposits in intervertebral discs, apophysial joints, and ligaments.


CONCLUSIONS
In long-term hemodialysis patients, cauda equina compression may develop as the consequence of beta 2 microglobulin amyloid deposition in lumbar intervertebral discs, facet joints, and ligaments. Magnetic resonance imaging is well suited to show the extent of the compression and supports the argument for the amyloid origin of extradural soft tissue.
Marcelli
C
C
Division of Rheumatology, Lapeyronie University Hospital, Montpellier, France.
Pérennou
D
D
Cyteval
C
C
Leray
H
H
Lamarque
J L
JL
Mion
C
C
Simon
L
L
D000328:Adult; D000368:Aged; D000686:Amyloidosis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D002420:Cauda Equina / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D009192:Myelography; D009408:Nerve Compression Syndromes / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006435:Renal Dialysis / Q000009:adverse effects*; D012600:Scoliosis / Q000150:complications / Q000000981:diagnostic imaging; D013122:Spinal Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D014057:Tomography, X-Ray Computed