Surgical Intervention for Spinal Lesions Due to Multiple Myeloma: A Case Report

Abstract

Vertebral disease is a main source of morbidity (MM) in individuals with multiple myeloma. The effects of associated osteolytic lesions and vertebral fractures on severe pain, functional limits, spinal deformity, and cord compression are well recognized. Systemic therapy, radiation, cementoplasty (vertebroplasty/kyphoplasty), and radiofrequency ablation are now available therapeutic options for severe MM spinal pain. We here reported a case of a 45-year-old male who had complained of progressive symptoms of pathological spine fractures. He had been examined and investigated for the cause of lytic lesions and found to have multiple fractures in the spine. A computed tomography (CT) revealed multiple osteolytic lesions noted in the thoracolumbar spine, ribs (bilaterally), and pelvic bones. Magnetic resonance imaging (MRI) showed a compression fracture of the T8 vertebral body with evidence of retro-bulging and a spinal canal narrowing. However, there was no evidence of spinal cord abnormal signal intensity. T2 weighted image (T2WI) keeping with edema is noted. A surgical intervention fixed the fracture and improved the quality of life. Vertebroplasty, a minimally invasive procedure, as a treatment option for vertebral lesions and pathologic fractures in the MM, showed good clinical improvement in the patient.

Keywords: fractures; multiple myeloma; osteolytic lesions; saudi arbia; spinal fracture.

Figure 1. CT scan of the chest and abdomen with oral and IV contrast revealed an osteolytic lesion noted in the thoracic spine

Figure 2. CT scan of the chest and abdomen with oral and IV contrast revealed an osteolytic lesion noted in the thoracic spine

Figure 3. A CT scan of the chest and abdomen with oral and IV contrast, revealed multiple osteolytic lesions in the thoracolumbar spine

Figure 4. A CT scan of the chest and abdomen with oral and IV contrast, revealed multiple osteolytic lesions in the thoracolumbar spine and pelvic bones

Figure 5. A spine MRI without contrast revealed a compression fracture of the T8 vertebral body with evidence of retro-bulging and a spinal canal narrowing

Figure 6. A venous doppler of the right upper limb showed a dilated non-compressible median cubital vein extending to a cephalic vein with echogenic thrombus totally occluded its lumen with no color flow and doppler spectral waves at its course in the forearm