AMYLOIDOSIS-RELATED CAUDA-EQUINA COMPRESSION IN LONG-TERM HEMODIALYSIS-PATIENTS - 3 CASE-REPORTS

Study Design. These case reports illustrate the neurologic manifestati ons due to beta(2) microglobulin amyloid deposition at the lumbar spin e level in long-term hemodialysis patients. Objective. Radiologic inve stigations suggested the amyloid origin of extradural Soft tissue depo sition, which was confirmed by histologic examination after surgical e xcision. Summary of Background Data. 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. Method s. Three case reports of cauda equina compression in long-term hemodia lysis patients are presented. Follow-up radiography, computed tomograp hy, and magnetic resonance imaging were performed and patients underwe nt surgical decompression of the thecal sac. Results. In two patients, the compression resulted from the development of a destructive spondy larthropathy, and from the infiltration of extradural spaces and ligam ents by an abnormal soft tissue. The third patient had lumbar spinal s tenosis due to multiple disc protrusion and to hypertrophy of facet jo ints acid ligamentum flavum. Multilevel laminectomies enabled excision of an abnormal fibrous tissue responsible for the thecal sac compress ion. Histologic examination of the excised fibrous tissues disclosed a myloid deposits in intervertebral discs, apophysial joints, and ligame nts. Conclusions. In long-term hemodialysis patients, cauda equina com pression may develop as the consequence of beta(2) microglobulin amylo id deposition in lumbar intervertebral discs, facet joints, and ligame nts. Magnetic resonance imaging is well suited to show the extent of t he compression and supports the argument for the amyloid origin of ext radural soft tissue.