b sub(2)-Microglobulin amyloidosis caused spinal cord compression in a long-term haemodialysis patient

Study design:A case report of cervical myelopathy caused by epidural b sub(2)-microglobulin (b2m) amyloid deposits in a 50-year-old woman with haemodialysis treatment.Objective:Long-term haemodialysis in patients with end-stage renal disease leads to several complications based on b2m deposits, which can affect, in the cervical spine, the intervertebral disk, and in rare cases, they may compress the spinal cord and nerves. The objective of this report is to describe the clinical and radiological follow-up preceding the indispensable surgical excision of an amyloid mass in a 50-year-old woman with haemodialysis treatment. Long-term postoperative cervicalgia owing to subcondylian bone cyst-associated atlanto-occipital instability is also described and discussed.Setting:Department of Neurosurgery A, Hop Pellegrin, Bordeaux, France.Case report:We present a clinical case of a patient with spinal cord compression. The patient was treated by surgical excision of an amyloid mass subsequent to a C2-C3 laminectomy. The patient experienced clinical improvement with a regression of all of her neurological symptoms. Histological findings confirm the diagnosis of b2m amyloid deposition. However, 5 years after surgery the subcondylian bone cysts were still observed and atlanto-occipital instability required her to wear a minerva. Conclusion:Our case report confirms that surgical excision of b2m epidural deposits is necessary and relevant when neurological prognosis is discussed, and that pain is still the major symptom of disease evolution. The use of high-flux synthetic membranes could decrease the b2m blood level and early renal graft is the only method to prevent such complications.Spinal Cord (2007) 45, 322-326. doi:10.1038/sj.sc.3101969; published online 22 August 2006