Multiple Myeloma and Epidural Spinal Cord Compression : Case Presentation and a Spine Surgeon's Perspective
A 62-year-old woman with no significant medical background, presented with upper back pain for one month and progressive lower extremity numbness and weakness. She was unable to walk unaided in the last several days and had developed urinary incontinence. A neurological examination revealed bilateral lower extremity weakness with grade IV strength, decreased deep and superficial sensation, a tingling sensation below the umbilicus and increased knee jerk. Initial laboratory tests revealed a hemoglobin of 14.0 g/dL, white cells of 8200/mm3, erythrocyte sedimentation rate of 120 mm/h, and elevated serum total protein of 10.1 g/dL (normal range, 6.6-8.3 g/dL), but she did not have renal or hepatic insufficiency. Additional laboratory tests including a bone marrow biopsy revealed κ chain immunoglobulin G (IgG) multiple myeloma. On magnetic resonance imaging (MRI) of the entire spine that was taken to evaluate the neurological condition, an epidural mass was found to compress the spinal cord posteriorly, extending from the C7 to T2 vertebra. The epidural mass was hypointense to the spinal cord on T1-weighted images and hyperintense on T2-weighted images, with moderate contrast enhancement. No pathological fracture of the adjacent vertebra was found. High-dose steroid therapy (dexamethasone, 40 mg/day) and emergent radiotherapy were performed under the diagnosis of MM and spinal cord compression. Before this medical treatment, her neurological status was Frankel B. MRI, checked after 3000 cGy fractioned radiotherapy for the C7-T2 lesion, revealed complete resolution of the epidural mass (). However, during 6 months of follow-up, the patient did not experience any neurological improvement (final neurological status, Frankel B).