Moger Nagaraj Manju, Ifthekar Syed, Ahuja Kaustubh, Mittal Samarth, Pragadeeshwaran J, Kandwal Pankaj
Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
J Orthop Case Rep. 2020 Sep;10(6):23-27. doi: 10.13107/jocr.2020.v10.i06.1860.
Malignant bone tumors of the spine are extremely rare with an incidence of 0.05% of primary neoplasms. Solitary plasmacytoma of the vertebra accounts for about 30% of the total within this group.
A 23-year-old female presented to spine clinic, with complaints of low back pain, deformity in lower back, and difficulty in walking for 3 months duration. Radiological investigations revealed destruction of L3 vertebra with soft-tissue mass around it. USG-guided biopsy from the lesion was suggestive of plasma cell dyscrasia. Routine blood investigations showed no abnormality. Urine myeloma profile and immunoelectrophoresis were done which were within normal limit and ruled out multiple myeloma. Due to the profound neurological deficit and existing instability, the patient underwent decompression, resection of tumor, anterior column reconstruction with cage, and instrumented posterior and posterolateral fusion (360° fusion) from L1-L5, before radiotherapy. The patient was subjected to 23 cycles of intensity-modulated radiotherapy and is doing good on subsequent follow-ups with good fusion.
Solitary plasmacytoma of vertebra when associated with neurological deficit and/or instability should be treated with spinal stabilization surgery followed by radiotherapy to achieve good and overall predictable outcomes.
脊柱恶性骨肿瘤极为罕见，占原发性肿瘤的0.05%。椎体孤立性浆细胞瘤约占该组病例总数的30%。
一名23岁女性因下腰痛、下背部畸形及行走困难3个月就诊于脊柱门诊。影像学检查显示L3椎体破坏，周围有软组织肿块。在超声引导下对病变进行活检，提示浆细胞异常增殖。常规血液检查未见异常。进行了尿骨髓瘤谱和免疫电泳检查，结果均在正常范围内，排除了多发性骨髓瘤。由于存在严重的神经功能缺损和现有不稳定情况，患者在放疗前接受了减压、肿瘤切除、椎间融合器前路椎体重建以及L1-L5节段的后路和后外侧器械固定融合术（360°融合）。患者接受了23个周期的调强放疗，后续随访情况良好，融合效果佳。
当椎体孤立性浆细胞瘤伴有神经功能缺损和/或不稳定时，应采用脊柱稳定手术治疗，随后进行放疗，以获得良好且总体可预测的结果。
