Multiple Myeloma Presenting with Spinal Cord Compression

Abstract

The clinical features, treatment, and course of 6 patients with multiple myeloma, who presented initially with spinal cord compression, are reviewed. These 6 represent 12% of all patients with myeloma seen at our institution since 1979. Eighty-three similar patients were identified from the medical literature. There are no patient characteristics predictive for this presentation. A higher than expected proportion of patents have clinically localized disease, but progression to myelomatosis is common. As these patients present without a known diagnosis of malignancy, a prompt, invasive diagnostic procedure and the immediate institution of definitive local therapy is mandatory. Despite such an aggressive approach, the prospect for significant return of neurologic function is poor. Survival does not appear to be different from that of other patients with myeloma. Unlike other malignancies, a presentation with cord compression is not inconsistent with long-term survival, although significant morbidity secondary to the resultant functional disability can be expected.

Identifying osteoporotic vertebral endplate and cortex fractures

“…VF happens in 50-70% of patients with multiple myeloma. It may lead to spinal cord compression in 15% of the patients (66,67). Many vertebral compression fractures in patients with multiple myeloma appear benign on MR imaging ( Figure 58).…”

Magnetic Resonance and Computed Tomography Imaging in Multiple Myeloma

“…Vertebral compression fractures are observed in up to 80% of patients and compression of neurological structures occurs in up to 20% of them secondary to bone displacement or soft tissue masses. 33,34 Figure 4 Correlation of radiographic with CT findings in a 54year-old man presenting with sudden back pain without known disease. Lateral radiograph of the lumbar spine shows diffuse heterogeneous osteoporosis and compression fracture of the L3-vertebral body (A).…”

The role of radiography in the study of spinal disorders

“…Osteopenia and osteolytic lesions may present separately or in association. Vertebral fractures have been reported in 50-70% of patients with MM (158,159). It is noteworthy to know that the radiographic appearance of MM may resemble that of OVFs, and the topographic distribution of the fractures is similar in both cases (158) (Figure 31).…”