title: Total spondylectomy for solitary bone plasmacytoma of the lumbar spine in a young woman: a case report and review of literature.
abstract: BACKGROUND
  Solitary bone plasmacytoma (SP) is a rare diagnosis for which the primary treatment is local radiotherapy. There is no established consensus suggesting a total spondylectomy in spinal SP.
  
  
  METHODS
  We report the case of a 43-year-old woman with solitary plasmacytoma of the lumbar spine treated with complete vertebral resection. Radiographs, CT scan and MRI showed a single osteolytic lesion of the third lumbar vertebra. Further diagnostics following recommended algorithm for tumour screening were negative. Two times, biopsy showed no histological pathologies. Due to the instability of the spine with suspicious unknown lesion, we decided to perform a dorsal lumbar approach and instrumentation with complete resection of the posterior parts to prepare for a complete resection if mandatory. Resamples were taken and the bone surfaces sealed. Consecutive findings were positive for plasma cell infiltration of the respective vertebra, however not on the first pass, but after diagnostic pathological reference. Surgery was completed by total spondylectomy. Reference histological findings with restaging and cytogenetic risk analysis confirmed a non-high-risk solitary bone plasmacytoma, and the patient was scheduled for localized radiotherapy with 40 Gy.
  
  
  RESULTS
  Follow-up examinations (53 months) showed no local recurrence or disease progression.
  
  
  CONCLUSIONS
  There is no consensus in the literature regarding appropriate surgical approach and perioperative strategies in the treatment of solitary plasmacytoma. The finding of a solitary plasmacytoma of the spine was the determining factor for our decision to perform radical surgery with subsequent radiotherapy. The rationale for the chosen approach was to minimize the risk of local recurrence and to avoid conversion into multiple myeloma. The follow-up with 53 months is limited. However, discussion remains, if radical surgery in addition to local radiotherapy could be an alternative therapeutic approach depending on paraclinical parameters, age and cytogenetic risk analysis.
authors.affiliation: Department of Orthopaedic Surgery, University Hospital Leipzig, 04103, Leipzig, Germany.
authors.forename: Nicolas H
authors.initials: NH
authors.lastname: von der Hoeh
authors.forename: Sven Kevin
authors.initials: SK
authors.lastname: Tschoeke
authors.forename: Jens
authors.initials: J
authors.lastname: Gulow
authors.forename: Anna
authors.initials: A
authors.lastname: Voelker
authors.forename: Udo
authors.initials: U
authors.lastname: Siebolts
authors.forename: Christoph-Eckhard
authors.initials: CE
authors.lastname: Heyde
mesh_terms: D000328:Adult; D001706:Biopsy; D001859:Bone Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D009101:Multiple Myeloma / Q000000981:diagnostic imaging; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D019637:Orthopedic Procedures; D010954:Plasmacytoma / Q000473:pathology* / Q000601:surgery*; D013131:Spine / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed