title: Multiple myeloma presenting with acute bony spinal cord compression and mechanical instability successfully managed nonoperatively.
abstract: Multiple myeloma (MM) with spinal involvement may present with spinal cord or cauda equina compression, with or without neurological impairment. This occurs when a soft-tissue myelomatous mass extends into the epidural space (Barron et al., 1959 [1]). The mainstay of management for such lesions in patients with normal neurology is chemotherapy and radiotherapy or radiotherapy alone, but those with neurological compromise require surgical decompression with adjuvant therapy (Patchell et al., 2005 [2]). Infrequently, patients with MM present with spinal cord compression and neurological impairment due to bony encroachment from vertebral translation and kyphosis where significant lytic bone disease has rendered the spine mechanically unstable. The standard management for these patients is surgical decompression and internal fixation.
  
  
  
  This study aimed to report a high-risk myeloma patient with a mechanically unstable spine, acute spinal cord compression, and neurologic deficit that was treated successfully using nonoperative means.
  
  
  
  Case report.
  
  
  
  A 37-year-old male patient with MM was referred to our tertiary referral spinal unit with acute bony spinal cord compression and neurological impairment. Computer tomography revealed lytic lesions of T2 and T3 and anterolisthesis of T1 on T2 producing mechanical instability and magnetic resonance imaging confirmed extension of disease into the epidural space and cord compression. This was successfully managed with nonoperative treatment using a brace.
  
  
  
  Management in a brace restored clinical and radiological stability and normal neurological function.
  
  
  
  Certain high-risk myeloma patients with a mechanically unstable spine, acute spinal cord compression and neurologic deficit can be treated effectively in an appropriate brace when managed by a tertiary referral spinal unit.
authors.affiliation: Spinal Deformities Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK. Electronic address: kgokaraju@hotmail.com.
authors.forename: Kishan
authors.initials: K
authors.lastname: Gokaraju
authors.affiliation: Spinal Deformities Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Butler
authors.affiliation: Spinal Deformities Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
authors.forename: Adam
authors.initials: A
authors.lastname: Benton
authors.affiliation: Spinal Deformities Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Suarez-Huerta
authors.affiliation: Spinal Deformities Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
authors.forename: Susanne
authors.initials: S
authors.lastname: Selvadurai
authors.affiliation: Spinal Deformities Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
authors.forename: Sean
authors.initials: S
authors.lastname: Molloy
mesh_terms: D000328:Adult; D001915:Braces; D019299:Decompression, Surgical / Q000379:methods; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009101:Multiple Myeloma / Q000150:complications* / Q000000981:diagnostic imaging; D019637:Orthopedic Procedures; D013117:Spinal Cord Compression / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D014057:Tomography, X-Ray Computed / Q000009:adverse effects