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Myelopathy caused by hypertrophy of the posterior longitudinal ligament of the cervical spine in a patient with long-term hemodialysis Junichi MIZUNO 1 , Hiroshi NAKAGAWA 1 , Yoshio HASHIZUME 2 1Department of Neurological Surgery, Aichi Medical University 2Institute for Medical Science of Aging, Aichi Medical University Keyword: posterior longitudinal ligament , ossification , hypertrophy , amyloid , hemodialysis pp.655-659
Published Date 1996/7/10
DOI https://doi.org/10.11477/mf.1436901244
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A 48-year-old female was admitted to our hospital because of progressive gait deterioration over a period of 4 months. She had been treated by hemodialysis for 14 years after bilateral nephrectomy. She originally suf-fered achondroplasia. Otherwise she was a healthy woman.

Neurological examination showed weakness and hypesthesia below C5, accelerated deep tendon reflexes and inability in walking. T1 weighted magnetic reso-nance imaging revealed severe cord compression from C4 to C6 due to an epidural isointensity mass located in the ventral surface of the dura. This mass was en-hanced by a contrast medium. Anterior decompression followed by an autogenous vertebral bone graft at C4/5 and C5/6 was performed. The posterior longitudinal ligament was remarkably thickened resulting in severe cord compression. Histologically this thick ligament contained amyloid deposition both in the superficial and deep layers. Ossification was not noticed in the ligament. Diagnosis of hypertrophy of the posterior lon-gitudinal ligament (HPLL) was made. HPLL is known to be frequenthy associated with herniated interverte-bral discs or segmental ossification of the posterior lon-gitudinal ligament (OPLL).

Myelopathy in this patient with long-term hemodialy-sis was aggravated by HPLL without ossification due to imbalance of systemic metabolism such as amyloido-sis. The authors report a unique case of HPLL caused by amyloidosis as one of the complications of chronic hemodialysis with special emphasis on its pathophy-siology and management.


Copyright © 1996, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院

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