A significant proportion of patients undergoing spinal stenosis decompression surgery were found to have abnormal amyloid deposits in their spine, according to a study recently published in the Journal of General and Family Medicine. Amyloid deposition is typically associated with transthyretin amyloid cardiomyopathy (ATTR-CM), suggesting that screening spinal stenosis patients for ATTR-CM could help diagnose the disease at earlier stages.
Spinal stenosis is a condition in which spaces within the spine narrow abnormally, resulting in pressure on the spinal cord and nerves. Patients with spinal stenosis often experience symptoms such as pain, numbness and weakness, in addition to symptoms associated with nerve damage, such as loss of bladder control.
In such cases, decompression surgery can help alleviate the pressure building inside the spine. It is estimated that more than 65,000 patients are treated for lumbar spinal stenosis every year. This may represent an opportunity for doctors to identify undiagnosed cases of ATTR-CM, the study’s authors noted.
In ATTR-CM, amyloid deposition in the heart causes the heart to function inadequately, potentially causing heart failure. The same amyloid deposition that happens in the heart can also occur in the spine, contributing to spinal problems.
Researchers recruited patients over 60 years of age who were being treated for spinal stenosis with decompression surgery between October 2020 and December 2021 at Boston Medical Center. The research team obtained samples from each patient’s spine to test for levels of amyloid deposition. Patients who had evidence of amyloid deposition in their spine underwent additional tests to evaluate the health of their heart.
Read more about ATTR-CM testing and diagnosis
A total of 54 patients took part in this study, with 24 of these patients (44%) found to have abnormal amyloid deposits in their spine. Patients who were found to be amyloid-positive were generally older compared with those who were found to be amyloid-negative. Of these 24 patients, 21 had already undergone tests related to the health of their heart, such as imaging scans.
Additional testing for these 24 patients with regards to a diagnosis of ATTR-CM all proved to be negative. However, researchers noted some abnormalities in the biomarkers typically used to gauge the health of the heart; for example, median N-terminal pro-brain natriuretic peptide (NT-proBNP) and BNP levels were significantly elevated among those with spinal amyloid deposits. Cardiac imaging abnormalities were also noted. Combined, these findings suggest that patients with spinal amyloid deposits might be showing signs of early heart disease.
“Although symptomatic spinal stenosis alone is insufficient to infer the presence of concurrent ATTR-CM, further studies are warranted to determine the time span between the development of spinal stenosis and ATTR-CM to inform the development of screening protocols,” the research team concluded.
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