Ito M, Abumi K, Takeda N, Satoh S, Hasegawa K, Kaneda K
Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Sapporo, Japan.
Spine (Phila Pa 1976). 1998 Oct 1;23(19):2127-33. doi: 10.1097/00007632-199810010-00018.
Pathologic features of hemodialysis-associated spinal disorders were evaluated using preoperative radiographic images and histologic findings of the spinal lesions resected during surgery.
To investigate the pathology of hemodialysis-related spinal disorders and to determine the role of amyloidosis in the establishment of severe destruction of the spine.
The pathologic events leading to hemodialysis-associated spinal disorders are poorly understood. The distribution of amyloid deposits in the spine also has not been clarified.
Twenty patients with hemodialysis-associated spinal disorders were investigated regarding pathologic features of neural compression and spinal destruction. Preoperative radiographic images such as plain radiography, tomography, computed tomography, magnetic resonance imaging, and scintigraphy were assessed for the existence of an intracanal mass, hypertrophy of the ligamentum flavum, and destructive changes of the spinal components. Histologic examination also was conducted by light microscopy and scanning electron microscopy to determine the distribution pattern of amyloid deposits in the spinal components.
Six patients with no destructive changes in the spine showed spinal canal stenosis. In the cervical spine, a main factor associated with spinal canal stenosis was the presence of intracanal amyloid deposits in three patients. In the lumbar spine, a main factor associated with spinal canal stenosis was hypertrophied ligamentum flavum in three patients. Destructive changes of the facet joints, intervertebral disc, and vertebral body were seen in the other 14 patients. Amyloid deposits were densely distributed at the enthesis of capsular fibers to the bone and in anular tears in the intervertebral discs. Vertebral end plates were destroyed by penetration of amyloid granulation into the vertebral body. Osteoclast activity in the destroyed vertebral bodies was enhanced, with no evidence of new bone formation.
Amyloid deposits played an important role in the progression of spinal destruction and severe instability.
利用术前影像学图像以及手术中切除的脊柱病变的组织学发现，评估血液透析相关脊柱疾病的病理特征。
研究血液透析相关脊柱疾病的病理学，并确定淀粉样变性在脊柱严重破坏形成过程中的作用。
导致血液透析相关脊柱疾病的病理过程尚不清楚。脊柱中淀粉样沉积物的分布也未得到阐明。
对20例血液透析相关脊柱疾病患者的神经受压和脊柱破坏的病理特征进行了研究。评估术前影像学图像，如X线平片、体层摄影、计算机断层扫描、磁共振成像和闪烁扫描，以确定椎管内肿块、黄韧带肥厚以及脊柱结构的破坏情况。还通过光学显微镜和扫描电子显微镜进行组织学检查，以确定脊柱结构中淀粉样沉积物的分布模式。
6例脊柱无破坏改变的患者出现椎管狭窄。在颈椎，3例患者椎管狭窄的主要相关因素是椎管内淀粉样沉积物的存在。在腰椎，3例患者椎管狭窄的主要相关因素是黄韧带肥厚。其他14例患者出现了小关节、椎间盘和椎体的破坏改变。淀粉样沉积物密集分布于关节囊纤维与骨的附着处以及椎间盘的环状撕裂处。淀粉样肉芽组织侵入椎体导致椎体终板破坏。破坏的椎体中破骨细胞活性增强，未见新骨形成的证据。
淀粉样沉积物在脊柱破坏和严重不稳定的进展中起重要作用。
