Hemodialysis-related upper cervical extradural amyloidoma presenting with intractable radiculopathy

Abstract

Introduction Destructive spondyloarthropathy may occur in long-term hemodialysis patients, but focal amyloid deposits in the spine are rare. We present a case of upper cervical extradural amyloidoma with a history of long-term hemodialysis presenting with progressive and intractable radiculopathy. Clinical presentation We describe a 51-year-old female with a long-term history of hemodialysis treatment. She suffered progressive and intolerable right occipital headache. Neurological examination revealed right C2 radiculopathy. Magnetic resonance imaging (MRI) of the cervical spine showed a solid focal extradural mass lesion at the C2 level. She underwent subtotal resection of the extradural mass lesion and decompression of the right C2 nerve root by a posterior approach. Histological examination revealed amyloid deposits. The occipital headache immediately disappeared after surgery. Follow-up MRI 10 months after surgery demonstrated no recurrence of the extradural amyloidoma. Conclusion Development of an upper cervical extradural amyloidoma after long-term hemodialysis is extremely rare. Prompt evaluation of long-term hemodialysis patients suffering from progressive cervical pain should be recommended, and treatment is required if there are signs or symptoms of compression of a nerve root or the spinal cord.

Primary cervical spine AL‐κ amyloidoma: A case report and review of the literature

“…Reports of spine amyloidomas are rare: 20 cervical, 20 thoracic, five lumbar, one cervicothoracic, and one thoracolumbar have been published. Cases of cervical amyloidoma are presented in Table .…”

“…Of the reported MRI results, the majority described hypointensity on T1 (71.43%) and T2 (50%) with enhancement (90%). Of the reported post‐operative results, most improved (50%) or resolved (43.75%) …”

Primary amyloidoma in epidural and paravertebral space of the lumbar spine

“…With regard to epidural amyloidoma without bone involvement, there are only a few reports even with secondary amyloidoma [8][9][10].…”

Intradural, extramedullary amyloidoma involving cervical and thoracic spine

“…Of these, 16 were cervical [5,10,11,[15][16][17][18]24,[27][28][29]31,33,35,37,41], 19 were thoracic [1,3,4,[7][8][9][19][20][21][22][23]26,30,32,34,36,[38][39][40], three were lumbar [2,13,25] and one was thoracolumbar [6]. Notably, all reported patients describe extradural amyloidomas making our patient, to our knowledge, the first with an intradural, extramedullary amyloidoma.…”