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Prevalence Of Amyloid In Ligamentum Flavum Of Patients With Lumbar Spinal Stenosis London Spine

This article discusses a study that aimed to assess the prevalence of transthyretin (ATTR) amyloidosis in patients undergoing surgery for lumbar spinal stenosis (LSS). The researchers conducted tissue biopsies of the ligamentum flavum in patients aged over 50 and screened the samples for amyloid using Congo red staining and immunohistochemistry. The results showed that amyloid was detected in 78.7% of the patients, with ATTR being the most common subtype. The thickness of the ligamentum flavum was significantly higher in patients with amyloid. The findings suggest that histopathological examination of the ligamentum flavum may aid in the early diagnosis of ATTR amyloidosis

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

CONCLUSIONS: Amyloid, mostly of the ATTR subtype, was found in four out of five patients with LSS and is associated with age and ligamentum flavum thickness. Histopathological work-up of ligamentum flavum might inform future decision making.

Spine Lumbar Spinal Stenosis Expert. Best Spinal Surgeon UK
Abstract Background: Transthyretin (ATTR) amyloidosis is often diagnosed in an advanced stage, when irreversible cardiac damage has occurred. Lumbar spinal stenosis (LSS) may precede cardiac ATTR amyloidosis by many years, offering the opportunity to detect ATTR already at the time of LSS surgery. We prospectively assessed the prevalence of ATTR in the ligamentum flavum by,

Abstract

Background: Transthyretin (ATTR) amyloidosis is often diagnosed in an advanced stage, when irreversible cardiac damage has occurred. Lumbar spinal stenosis (LSS) may precede cardiac ATTR amyloidosis by many years, offering the opportunity to detect ATTR already at the time of LSS surgery. We prospectively assessed the prevalence of ATTR in the ligamentum flavum by tissue biopsy in patients aged >50 years undergoing surgery for LSS.

Methods: Ligamentum flavum thickness was assessed pre-operatively on axial T2 magnetic resonance imaging (MRI) slices. Tissue samples from ligamentum flavum were screened centrally by Congo red staining and immunohistochemistry (IHC).

Results: Amyloid in the ligamentum flavum was detected in 74/94 patients (78.7%). IHC revealed ATTR in 61 (64.9%), whereas amyloid subtyping was inconclusive in 13 (13.8%). Mean thickness of ligamentum flavum was significantly higher at all levels in patients with amyloid (p < .05). Patients with amyloid deposits were older (73.1 ± 9.2 vs. 64.6 ± 10.1 years, p = .01). No differences in sex, comorbidities, previous surgery for carpal tunnel syndrome or LSS were observed.

Conclusions: Amyloid, mostly of the ATTR subtype, was found in four out of five patients with LSS and is associated with age and ligamentum flavum thickness. Histopathological work-up of ligamentum flavum might inform future decision making.

Keywords: Early diagnosis; ligamentum flavum; lumbar spinal stenosis; magnetic resonance imaging; transthyretin amyloid.

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Prevalence of amyloid in ligamentum flavum of patients with lumbar spinal stenosis

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Abstract Background: Transthyretin (ATTR) amyloidosis is often diagnosed in an advanced stage, when irreversible cardiac damage has occurred. Lumbar spinal stenosis (LSS) may precede cardiac ATTR amyloidosis by many years, offering the opportunity to detect ATTR already at the time of LSS surgery. We prospectively assessed the prevalence of ATTR in the ligamentum flavum by

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