Hemodialysis-associated amyloidosis with cervical spinal cord compression and incomplete tetraplegia: a case report

Abstract

Study design: Case report. Objectives: To report a rare case of hemodialysis-associated amyloidosis of cervical spinal canal with incomplete tetraplegia in long-term hemodialysis patient. Settings: Traumatology Clinic, Zagreb; Spinal Unit, Varazdinske Toplice, Croatia. Methods: Forty-seven-year-old male patient at long-term hemodialysis treatment developed progressive limbs weakness, graded as C4 ASIA C. Cervical computed tomography myelography showed extreme narrowing of the spinal canal. Decompressive laminectomy with bilateral foraminotomies was performed and histological examination revealed amyloidal deposition. Results: Rehabilitation program started immediately after surgery with physical and occupational therapy, along with psychological support aiming at restoring full activities of daily living. Three months after surgery, the patient returned to his community, neurologically improved to ASIA E. Hemodialysis program was regularly maintained perioperatively and during the rehabilitation. Conclusion: Vertebral involvement with neurological deterioration in hemodialysis-associated amyloidosis patients prompts for early diagnosis, surgical and rehabilitation management, in this instance with good outcome.

Cervical destructive spondyloarthropathy due to the dialysis-related amyloidosis: imaging findings

“…The pathology diagnosis is made with hematoxylin-eosin and Congo red. Under polarized light, these areas exhibit characteristic applegreen birefringence [1] (Figure 3). In the treatment, medical therapy is limited to symptomatic approaches to reduce pain and inflammation.…”

“…It affects the osteoarticular system predominantly. The most common manifestations are arthropathy of the axial skeleton, knees, shoulders, hips and carpal tunnel syndrome [1]. Dialysisrelated spondyloarthropathy has been divided into three types: destructive spondyloarthropathy (DSA), amyloid deposition in spinal ligaments, and pseudotumor of the craniocervical junction (amiloidoma).…”

Hemodialysis-related upper cervical extradural amyloidoma presenting with intractable radiculopathy

“…Because the clinical presentation was mostly caused by a mass effect to the spinal root or spinal cord [3,4,7,[14][15][16], medical therapy is limited to symptomatic approaches to lessen pain and inflammation in joints [3]. Therefore, prompt evaluation of long-term hemodialysis patients suffering from cervical pain should be emphasized so that they can be referred for surgical evaluation.…”

“…It involves deposition of amyloid fibrils containing b2-microglobulin in collagen tissue (particularly in the synovia of joints and tendons) and in subchondral bone [3,4]. The most common manifestations are carpal tunnel syndrome and arthropathy of the shoulders, knees, hips, and axial skeleton [4].…”

Compressive Cervical Myelopathy Related with Hemodialysis-Associated Amyloidoma

“…The most common clinical manifestations are carpal tunnel syndrome and arthropathy of the shoulders, knees, hips, and axial skeleton, which can cause neurologic symptoms and pain. 2 Destructive spondyloarthropathy can occur in patients on long-term hemodialysis, but localized amyloid deposits in the spine are uncommon. 3 The management of spinal amyloidosis requires active local resection and stabilization of the spine, depending on the extent of the invasion.…”