Unraveling a rare cause of spinal stenosis: Coexistent AL and ATTR amyloidosis involving the ligamentum flavum

Amandeep Godara; Andy Y Wang; Knarik Arkun; Teresa Fogaren; Adnan S Qamar; Ellen D McPhail; James Kryzanski; Ron Riesenburger; Raymond Comenzo

doi:10.25259/SNI_1235_2021

Unraveling a rare cause of spinal stenosis: Coexistent AL and ATTR amyloidosis involving the ligamentum flavum

Surg Neurol Int. 2022 Jan 12:13:12. doi: 10.25259/SNI_1235_2021. eCollection 2022.

Authors

Amandeep Godara¹, Andy Y Wang², Knarik Arkun³, Teresa Fogaren⁴, Adnan S Qamar³, Ellen D McPhail⁵, James Kryzanski², Ron Riesenburger², Raymond Comenzo⁴

Affiliations

¹ Department of Hematology and Hematologic Malignancies, University of Utah, Salt Lake, Utah.
² Department of Neurosurgery, Tufts Medical Center, Washington, Boston, United States.
³ Department of Pathology and Laboratory Medicine, Tufts Medical Center, Washington, Boston, United States.
⁴ Department of John Conant Davis Myeloma and Amyloid Program, Tufts Medical Center, Washington, Boston, United States.
⁵ Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, New York, United States.

Abstract

Background: Amyloidosis is a protein misfolding disorder that leads to the deposition of beta-pleated sheets of a fibrillar derivative of various protein precursors. Identification of the type of precursor protein is integral in treatment decision-making. The presence of two different types of amyloid in the same patient is unusually rare, and there are no previous reports of two different types of amyloid deposition in the ligamentum flavum (LF) in the same patient.

Case description: Here, we describe two patients with spinal stenosis who underwent laminectomies and were found to have AL and ATTR amyloid deposits in the LF.

Conclusion: As the spine is becoming recognized as a site for ATTRwt amyloid deposition, patients undergoing spinal decompression surgery may potentially benefit from evaluation for amyloidosis in the LF.

Keywords: Ligamentum flavum; Light chain; Spinal stenosis; Wild-type transthyretin amyloid.

Publication types

Case Reports