Abstract
We performed spinal decompressive surgery in 14 hemodialysis patients, 7 with cervical myelopathy and 7 with lumbar radiculopathy. In four of the cases of cervical myelopathy the spinal cord was compressed by the deposition of amyloid in the hypertrophied posterior longitudinal and/or ligamentum flavum and epidural space. In two of the cases of lumbar canal stenosis the dural tube was compressed by the hypertrophied ligamentum flavum. The age range in these 6 cases was 51 to 68 years (average: 58.5) and the duration of hemodialysis ranged from 15 years to 20 years (average: 17.4). The hypertrophy of the posterior longitudinal ligament and the ligamenta flava was diagnosed preoperatively by MRI and CT-myelogram.
Surgery revealed hypertrophied ligamenta flava and adhesion of the dural tube to the spinal canal. Histopathological examination of the surgical specimens showed massive deposition of amyloid, which was histochemically identified as β2-microglobulin.
We consider hypertrophy of the posterior longitudinal ligament and ligamenta flava mainly due to amyloid deposition to be one of the major factors causing cervical myelopathy and lumbar spinal canal stenosis in longterm hemodialysis patients.
