Journal de colonne vertébrale et de neurochirurgie

Solitary Plasmacytoma of the Axial Spine and Dorsal Spine: Treatment Dilemmas and Review of Literature

Kongwad LI, Nair RP, Nayal B and Nagaraj A

Abstract Background: Solitary plasmacytoma of the spine accounts for 5% of plasmacytomas and is a rare entity [1]. More than 25- 60% of these lesions are localized in the dorsal spine and cause myelopathy in 42-71% of the patients. Diagnosis and treatment protocols have been established, however the final decision of whether to stabilize and irradiate locally versus direct irradiation is controversial. Many centers advocate different treatment protocols based on their institutional experience and patient outcomes. Clinical presentation: We present, herewith, our experience with a 63 year-old patient with upper dorsal solitary lesion, who presented with upper back pain and was diagnosed to have a D3-4 solitary plasmacytoma and another 44 year old patient who presented with spastic quadriparesis progressing to quadriplegia over the last 6 months, who had a C2 lytic lesion with instability. Conclusion: In the presence of solitary spinal lesions, despite the location, solitary plasmacytoma of the bone should be considered as one of the differential diagnosis. Abnormal proteinemia or proteinuria may often be absent, yet this entity is commonly encountered in clinical practice. Patients show clinical and neurological improvement with surgical decompression with/ without stabilization. Postoperatively, radiotherapy is advocated since it reduces the recurrence rates. Often confused with spinal tuberculosis, starting ATT can be detrimental to the patient since it delays the standard line of treatment.