Rishi Trivedi
The incidence of metastatic spinal cord compression (MSCC) is up to 80 cases per million people each year. MSCC maybe a feature of advanced primary cancer particularly in cancers of breast, lung, and prostate, however it could be a presenting complaint in up to 20% of malignancies. Treatment in MSCC usually involves a multidisciplinary approach with corticosteroids, radiotherapy, and surgery all playing a role. However, evidence has suggested that only 50% of patients have a positive response. Multiple myeloma (MM) is a B cell malignancy resulting in osteolytic lesions. Vertebral collapse and soft tissue extension of tumour into the spinal canal in multiple myeloma may cause neurological deficit and mechanical instability leading to pain and deformity. To date, there are no definitive guidelines for the treatment of spinal cord compression as a consequence of MM. Radiotherapy has frequently been the preferred form of treatment. Some surgeons, however, feel that spinal lesions in multiple myeloma should be treated in the same manner as spinal metastases from solid organs. I report the management of a 46-year-old gentleman with MM that had resulted in neural compression in the lumbar and thoracic areas. Emergent treatment in this patient consisted of spinal decompression and stabilisation.
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