Association between spinal stenosis and wild-type ATTR amyloidosis

Area of Science:

• Cardiovascular Medicine
• Neurology
• Rheumatology

Background:

• Age-related cardiac amyloidosis is linked to wild-type transthyretin amyloid (ATTRwt) deposits.
• ATTRwt may be associated with carpal tunnel syndrome (CTS) and spinal stenosis (SS), potentially indicating systemic amyloidosis.

Purpose of the Study:

• To investigate ATTR deposition in ligamentum flavum (LF) during spinal stenosis surgery.
• To assess the risk of concomitant cardiac amyloidosis in these patients.

Main Methods:

• Surgical LF specimens were Congo red stained and amyloid typed by mass spectrometry.
• Patients with positive specimens underwent comprehensive cardiac amyloidosis workup, including imaging and genetic testing.

Main Results:

• ATTRwt was identified in 13% (43/324) of patients undergoing surgery for SS.
• Two cases of ATTRwt cardiac amyloidosis were diagnosed and treated.
• Amyloid-positive patients were older and had a higher prevalence of CTS.

Conclusions:

• ATTRwt is prevalent in the LF of patients with SS, suggesting a systemic connective tissue involvement.
• Spinal stenosis may serve as a screening opportunity for systemic ATTR amyloidosis and associated cardiac risks.