Though transthyretin amyloid cardiomyopathy (ATTR-CM) is generally thought of as a progressive heart disease, the condition’s impact stretches far beyond the heart muscle. Among the many complications it can cause is spinal stenosis.
What is spinal stenosis?
Spinal stenosis is the narrowing of the spinal canal, which compresses the spinal cord and nerves within the spine. This pressure can mean patients have trouble walking longer distances, and feel pain or numbness in their legs.
Around 14% to 22% of patients with ATTR-CM also have lumbar spinal stenosis, where the condition affects the lower back. The connection between the two conditions has to do with the root cause of ATTR-CM itself.
Why ATTR-CM can cause neurological symptoms
In ATTR-CM, misfolded transthyretin protein accumulates in the heart and stiffens the heart muscle. But that’s not the only place transthyretin collects. It can also build up in the nervous system, which can result in neurological symptoms.
As time progresses, these amyloid deposits compromise the function of the nervous system. Common symptoms include sensory changes, such as tingling, numbness or a burning sensation; muscle weakness, resulting in difficulties walking or the carrying out of physical activities more generally; and dysfunction of various organs as a result of problems with nerve connection, such as constipation and urinary incontinence.
Read more about ATTR-CM testing and diagnosis
How spinal stenosis manifests in ATTR-CM
Normally, spinal stenosis occurs because of osteoarthritis. Osteoarthritis causes damage to the bone joints that results in the growth of bone spurs, which narrow the spinal column.
In ATTR-CM, spinal stenosis occurs when clumps of misfolded transthyretin protein accumulate in the ligamentum flavum, which are ligaments that run down the length of the spine. This causes the ligaments and tendons to become thicker, which narrows the spaces within the spinal canal
How is spinal stenosis treated?
Because the cause of spinal stenosis in ATTR-CM is the same as that of ATTR-CM itself, ATTR-CM therapies that slow or stop the accumulation of misfolded transthyretin protein can help slow spinal stenosis caused by the disease. However, none of the therapies currently approved for ATTR-CM remove transthyretin once it’s accumulated.
Treatments specifically for spinal stenosis include physical therapy to strengthen your back and legs muscles, medications to reduce pain, and in some cases, surgery. If you have spinal stenosis, your care team is your best resource for learning how to manage the condition.
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