Spinal cord compression in dialysis-related upper cervical amyloidoma - a case report

Dialysis-related amyloidosis (DRA) can lead to various degenerative conditions but rarely involves the spine with a spinal cord compression.

The authors describe a progressive tetraparesis (AIS-B) in a 57-year-old woman with upper cervical dialysis-related amyloidoma. Magnetic resonance imaging (MRI) showed a solid focal mass lesion at the C2-odotoid level with severe spinal cord compression. Computed tomography (CT) outlined multiple lytic lesions in C1 lateral masses and odontoid process. The patient underwent urgent surgical treatment. A posterior C1-C2 spinal cord decompression with biopsy followed by occipito-cervical posterior fixation was performed. Histopathological examination revealed amyloid deposits representing DRA. An immediately postoperative neurological improvement was observed.

Even if the spinal amyloidoma is extremely rare, this condition has to be suspected in a long-term hemodialysis patient suffering from progressive neurological deficits. Differential diagnosis is mandatory between infections, rheumatologic and neoplastic lesions. Imaging evaluation with CT and MRI is recommended in order to assess the characteristics of the pathological mass, the extension of lytic lesions and the entity of neurological compression. Surgical treatment is mandatory if clinical evidence of root or spinal cord compression is present.