Multiple Myeloma and Epidural Spinal Cord Compression : Case Presentation and a Spine Surgeon's Perspective
A 39-year-old woman presented with both shoulder and upper back pain for 1 month. A bone marrow biopsy was performed due to findings of an A/G ratio reversal, anemia, hypercalcemia and azotemia on laboratory tests revealed multiple myeloma. The findings of multiple punched out lesion in the skull and multiple osteolytic lesions over the spine on the radiological examination were matched with MM (IgG, λ chain). Computed tomography (CT) scans for the upper back pain revealed an epidural mass compressing the spinal cord. The initial neurological examination revealed normal motor and sensory functions of Frankel E grade. High-dose steroid therapy and fractioned radiotherapy (C7-T2, 3000 cGy) were conducted for the spinal cord compression lesion. After the ninth fraction of radiotherapy, she suddenly developed both lower extremity weakness, sensory disturbance below the T4 level and urinary incontinence (Frankel B). A follow-up MRI revealed sustained compression of the spinal cord by an epidural mass without any additional pathological fractures. An emergent decompressive laminectomy was performed. No pathological fractures of the posterior element of the involved spine were observed intraoperatively. A friable bluish gray colored soft tissue mass was found at the epidural space compressing the spinal cord with mild adhesion to the underlying dura. Coincident microscopic findings of multiple myeloma with <10% necrosis rates were observed from the excised mass (). At the 6 month follow-up after surgery, her neurological status remained unchanged (Frankel B).