Amyloid deposits derived from transthyretin in the ligamentum flavum as related to lumbar spinal canal stenosis.
2015 (English)In: Modern Pathology, ISSN 0893-3952, E-ISSN 1530-0285, Vol. 28, no 2, 201-207 p.Article in journal (Refereed) Published
Amyloidosis is a protein conformational disorder with the distinctive feature of extracellular accumulation of amyloid fibrils that come from different proteins. In the ligamentum flavum of the lumbar spine, amyloid deposits were frequently found in elderly patients with lumbar spinal canal stenosis and were at least partially formed by wild-type transthyretin. However, how amyloid deposits in the ligamentum flavum affect lumbar spinal canal stenosis has remained unclear. In this study, we analyzed clinical, pathologic, and radiologic findings of patients with lumbar spinal canal stenosis who had amyloid deposits in the ligamentum flavum. We studied 95 ligamentum flavum specimens obtained from 56 patients with lumbar spinal canal stenosis and 21 ligamentum flavum specimens obtained from 19 patients with lumbar disk herniation. We evaluated histopathologic findings and clinicoradiologic manifestations, such as thickness of the ligamentum flavum and lumbar spinal segmental instability. We found that all 95 ligamentum flavum specimens resected from patients with lumbar spinal canal stenosis had amyloid deposits, which we classified into two types, transthyretin-positive and transthyretin-negative, and that transthyretin amyloid formation in the ligamentum flavum of patients with lumbar spinal canal stenosis was an age-associated phenomenon. The amount of amyloid in the ligamentum flavum was related to clinical manifestations of lumbar spinal canal stenosis, such as thickness of the ligamentum flavum and lumbar spinal segmental instability, in the patients with lumbar spinal canal stenosis with transthyretin-positive amyloid deposits. To our knowledge, this report is the first to show clinicopathologic correlations in transthyretin amyloid deposits of the ligamentum flavum. In conclusion, transthyretin amyloid deposits in the ligamentum flavum may be related to the pathogenesis of lumbar spinal canal stenosis in elderly patients.Modern Pathology advance online publication, 5 September 2014; doi:10.1038/modpathol.2014.102.
Place, publisher, year, edition, pages
2015. Vol. 28, no 2, 201-207 p.
apolipoprotein A-I, lumbar spinal stenosis, senile systemic amyloidosis, transthyretin
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:uu:diva-239550DOI: 10.1038/modpathol.2014.102ISI: 000348956300004PubMedID: 25189643OAI: oai:DiVA.org:uu-239550DiVA: diva2:774805