Multiple Myeloma and Epidural Spinal Cord Compression : Case Presentation and a Spine Surgeon's Perspective

Abstract

Multiple myeloma, a multicentric hematological malignancy, is the most common primary tumor of the spine. As epidural myeloma causing spinal cord compression is a rare condition, its therapeutic approach and clinical results have been reported to be diverse, and no clear guidelines for therapeutic decision have been established. Three patients presented with progressive paraplegia and sensory disturbance. Image and serological studies revealed multiple myeloma and spinal cord compression caused by epidural myeloma. Emergency radiotherapy and steroid therapy were performed in all three cases. However, their clinical courses and results were distinctly different. Following review of our cases and the related literature, we suggest a systematic therapeutic approach for these patients to achieve better clinical results.

Keywords: Multiple myeloma; Spinal cord compression; Spine.

Fig. 1

Case 1. A : Sagittal T2-weighted magnetic resonance image (MRI) of the spine showing posterior epidural mass extending from the C7 to T1 vertebra. Multiple marrow signal changes are noted at the vertebral body. B : Follow-up MRI obtained 1 month after radiotherapy shows a complete epidural tumor response.

Fig. 2

Case 2. A and B : Sagittal and axial image of computed tomography (CT) scans showing multiple osteolytic lesions without pathological fracture of the vertebral column and an epidural mass compressing the spinal cord posteriorly (arrow head). C : A follow-up MRI taken after the ninth fractioned radiotherapy shows spinal cord compression caused by an epidural mass. D : Histological findings are consistent microscopic findings and multiple myeloma with a small portion of necrosis (arrow, H-E stain, ×100). E : A follow-up MRI obtained 1 month after the laminectomy shows no evidence of recurrence, but a signal change is noted in the spinal cord indicating myelopathy.

Fig. 3

Case 3. A : Before the diagnosis of multiple myeloma, the patient underwent posterior spine fusion for a multilevel compression fracture. B : Sagittal T-1 enhanced image shows the posterior epidural mass extending from T3 to T5 with a compression fracture at the T4 and T7 vertebra. C : A follow-up MRI obtained 1 month after radiotherapy shows a complete epidural mass response without progression of pathological compression fractures.

Fig. 4

Evaluation of patients with multiple myeloma and spinal involvement. VP : vertebroplasty, RT : radiotherapy.