Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

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

  • Ha, Kee-Yong (Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Young-Hoon (Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Hyun-Woo (Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • Received : 2013.01.14
  • Accepted : 2013.08.01
  • Published : 2013.08.28
Download PDF
⟨ Previous Next ⟩

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

References

  1. Avadhani A, Shetty AP, Rajasekaran S : Isolated extraosseous epidural myeloma presenting with thoracic compressive myelopathy. Spine J 10 : e7-e10, 2010
  2. Benson WJ, Scarffe JH, Todd ID, Palmer M, Crowther D : Spinal-cord compression in myeloma. Br Med J 1 : 1541-1544, 1979 https://doi.org/10.1136/bmj.1.6177.1541
  3. Damaj G, Mohty M, Vey N, Dincan E, Bouabdallah R, Faucher C, et al. : Features of extramedullary and extraosseous multiple myeloma : a report of 19 patients from a single center. Eur J Haematol 73 : 402-406, 2004 https://doi.org/10.1111/j.1600-0609.2004.00331.x
  4. Dürr HR, Wegener B, Krödel A, Müller PE, Jansson V, Refior HJ : Multiple myeloma : surgery of the spine : retrospective analysis of 27 patients. Spine (Phila Pa 1976) 27 : 320-324; discussion 325-326, 2002 https://doi.org/10.1097/00007632-200202010-00023
  5. Innes J, Newall J : Myelomatosis. Lancet 1 : 239-245, 1961
  6. Jin R, Rock J, Jin JY, Janakiraman N, Kim JH, Movsas B, et al. : Single fraction spine radiosurgery for myeloma epidural spinal cord compression. J Exp Ther Oncol 8 : 35-41, 2009
  7. Lim BS, Chang UK, Youn SM : Clinical outcomes after percutaneous vertebroplasty for pathologic compression fractures in osteolytic metastatic spinal disease. J Korean Neurosurg Soc 45 : 369-374, 2009 https://doi.org/10.3340/jkns.2009.45.6.369
  8. Lourbopoulos A, Ioannidis P, Balogiannis I, Stavrinou P, Koletsa T, Karacostas D : Cervical epidural plasmacytoma presenting as ascending paraparesis. Spine J 11 : e1-e4, 2011 https://doi.org/10.1016/S1529-9430(11)01462-8
  9. Matsui H, Fujie H, Tsuji H : Extraosseous epidural tumor of immunoglobulin D myeloma. J Spinal Disord 5 : 366-369, 1992 https://doi.org/10.1097/00002517-199209000-00017
  10. Okacha N, Chrif E, Brahim E, Ali A, Abderrahman E, Gazzaz M, et al. : Extraosseous epidural multiple myeloma presenting with thoracic spine compression. Joint Bone Spine 75 : 70-72, 2008 https://doi.org/10.1016/j.jbspin.2007.01.044
  11. Palmbach M, Hoffmann W, Grodd W, Postler E, Voigt K : Extraosseous, epidural tumour spread of multiple myeloma. Eur J Radiol 22 : 146-148, 1996 https://doi.org/10.1016/0720-048X(96)00754-1
  12. Prestwich RJ, Ackroyd S, Gilson D : Is surgery required in the management of spinal cord compression in myeloma patients? Clin Oncol (R Coll Radiol) 23 : 161, 2011 https://doi.org/10.1016/j.clon.2010.12.004
  13. Rades D, Huttenlocher S, Dunst J, Bajrovic A, Karstens JH, Rudat V, et al. : Matched pair analysis comparing surgery followed by radiotherapy and radiotherapy alone for metastatic spinal cord compression. J Clin Oncol 28 : 3597-3604, 2010 https://doi.org/10.1200/JCO.2010.28.5635
  14. Rades D, Veninga T, Stalpers LJ, Basic H, Rudat V, Karstens JH, et al. : Outcome after radiotherapy alone for metastatic spinal cord compression in patients with oligometastases. J Clin Oncol 25 : 50-56, 2007
  15. Renier JC, Brégeon C, Boasson M, Audran M, Emile J, Guy G, et al. : [Spinal cord compression in multiple myeloma. Study of 10 cases]. Rev Rhum Mal Osteoartic 51 : 193-196, 1984
  16. Wadleigh M, Tefferi A : Classification and diagnosis of myeloproliferative neoplasms according to the 2008 World Health Organization criteria. Int J Hematol 91 : 174-179, 2010 https://doi.org/10.1007/s12185-010-0529-5
  17. Wallington M, Mendis S, Premawardhana U, Sanders P, Shahsavar-Haghighi K : Local control and survival in spinal cord compression from lymphoma and myeloma. Radiother Oncol 42 : 43-47, 1997 https://doi.org/10.1016/S0167-8140(96)01858-0

Cited by

  1. Bone Cement Augmentation Procedures for Spinal Pathologic Fractures by Multiple Myeloma vol.30, pp.1, 2015, https://doi.org/10.3346/jkms.2015.30.1.88
  2. Myelosuppression, Bone Disease, and Acute Renal Failure: Evidence-Based Recommendations for Oncologic Emergencies vol.21, pp.5, 2013, https://doi.org/10.1188/17.cjon.s5.60-76
  3. Radiological imaging in multiple myeloma: review of the state-of-the-art vol.62, pp.8, 2013, https://doi.org/10.1007/s00234-020-02417-9
  4. Spinal Cord Compression as a Consequence of Spinal Plasmacytoma in a Patient with Multiple Myeloma: A Case Report vol.11, pp.1, 2013, https://doi.org/10.3390/clinpract11010018