Isolated Radiotherapy for Myeloma Lesions of the Cervical Spine: Case Report
Posted: Thursday, March 11, 2021
For patients with multiple myeloma who have osteolytic lesions of the cervical spine, isolated radiotherapy may be considered an alternative therapeutic option to restore spinal structural integrity, according to a case study published in the Journal of Surgical Case Reports. However, noted Joaquim Cruz Teixeira, MD, of Hospital CUF Infante Santo, Lisbon, Portugal, and colleagues, surgery should be considered in cases of significant spinal instability or deformity as well as potential neurologic injury.
The patient was a 73-year-old male who presented with right arm and cervical pain coinciding with the C5 and C6 dermatomes and a proximal and distal motor power grade II C5 motor deficit. In addition, the patient reported ipsilateral Hoffman’s sign. The physical exam did not reveal any significant findings. Further analysis of the cervical spine with CT and MRI revealed a lytic lesion within the C4, C5, and C6 vertebral bodies. Furthermore, there was a bilateral extension to the C4 and C5 posterior spinal elements. To assess the severity of their findings, the physicians utilized the Spinal Instability Neoplastic Score system. The lesion was characterized as unstable, with a notable risk of increased neurologic damage.
Moreover, serum protein electrophoresis was used to confirm the diagnosis of multiple myeloma. The patient was immediately treated with 5 fractions of 20 Gy of local three-dimensional external-beam radiotherapy and was placed in a Philadelphia cervical spine collar. This therapeutic intervention led to pain-free progression at the 3- and 6-month follow-up periods, with no neurologic deficits.
Disclosure: For full disclosures of the study authors, visit academic.oup.com.
