Epidural multiple myeloma causing thoracic cord compression: a case report
Njongo Wa, Ogutha LO, , Karanu JK, Mutiso VMb, Otsyeno.Fc, Atinga.Eb,
bDepartment
of Orthopaedic Surgery, University of Nairobi, Nairobi, Kenya
cDepartment
of Orthopaedic Surgery, Kenyatta National Hospital
Correspondence: wnjongo@gmail.com
Introduction:
Multiple myeloma is malignant multicentric hematopoietic neoplasm
characterized by errant proliferation of a single clone of plasma cells within the bone marrow 1.
This leads to accumulation of the malignant plasma cells in bone marrow, with subsequent
marrow compromise and destruction of bone. While this disease is typically multicentric, it most
commonly affects the anterior column of the spine, resulting in vertebral body collapse and cord
compression in 5% of cases2. Reports on epidural myeloma as a cause of cord compression are
rare3,4,5,6, It most commonly affects the spine, with symptoms occurring when the disease spreads
through the vertebral body cortex and invades the surrounding tissues. This results in vertebral
body collapse and subsequent spinal cord compression. We present an unusual case of spinal
cord compression as a result of epidural multiple myeloma, with no evidence of vertebral body
collapse or destruction. We highlight a case of multiple myeloma with sudden – onset paraplegia
resulting from a solitary epidural lesion.
Case Report: A 51 year old man was referred to our facility with a two day history of lower
back pain that was initially mild then increased in severity. This was followed by a sudden onset
of flaccid paraplegia and loss of sensation from the level of the nipples. These symptoms were
associated with chest pain and difficulty in breathing. There was no reported history of bone pain
or fever.
Laboratory investigations revealed the following:
 Haemogram – values within reference ranges
 Total serum protein 58 g/L (Albumin 26 g/L)
 Serum calcium – 1.89 mmol/L
 CRP – 323 mg/L
 Urea – 11.0 mmol/L
 Creatinine – 136 µmol/L
An initial CT scan of the thoracolumbar spine showed disc degenerative changes. However, no
lytic lesions or collapsed vertebral bodies were evident. On Magnetic Resonance Imaging (MRI)
of the spine, an epidural mass in the dorsal spinal canal was evident, causing anterior
displacement and compression of the spinal cord. There was involvement of associated spinous
processes, but the anterior column was spared. Decompression by T6 7 8 laminectomy was done
and the mass was found to involve the associated spinous processes and paraspinal muscles. The
excised tissue mass was sent for histopathological analysis. Sheets of malignant plasmacytoid
cells were observed and a plasma cell malignancy diagnosed. Urine electrophoresis showed no
Bence Jones proteinuria. A bone marrow aspirate showed malignant plasmacytoid cells
comprising 28% of the bone marrow cells, a feature diagnostic of multiple myeloma.The patient
is presently receiving radiotherapy.