Isolated extraosseous epidural myeloma presenting with thoracic compressive myelopathy

Abstract 

Background context

Multiple myeloma is the commonest primary malignancy of the spine, but it rarely presents as an extraosseous epidural tumor with only five cases reported in literature so far.

Purpose

The purpose of this study was to heighten awareness and treatment options of a rare case of extraosseous epidural myeloma.

Study design

The study design comprises a case report and literature review.

Methods

We present a 60-year-old lady with progressive paraplegia (American Spinal Injury Association grade C) with sensory blunting below T8 level of 2 months’ duration. Magnetic resonance imaging showed an extradural tumor in the dorsal epidural space from T6 to T7 without local bony involvement. She underwent a T6 and T7 laminectomy, T5–T8 pedicle screw instrumentation, and gross total resection of tumor. Histopathological diagnosis was consistent with myeloma. After surgery, the patient underwent local irradiation and adjuvant chemotherapy.

Results

Neurological improvement of one grade (American Spinal Injury Association grade C to D) was observed at 3 weeks postoperatively.

Conclusions

Isolated extraosseous epidural myeloma without destruction or collapse of vertebral bodies should be included in the differential diagnosis of epidural mass lesions causing spinal cord compression. The overall prognosis in terms of survival is poor, but early decompression can prevent neurological deterioration and improve quality of life.

Keywords: Epidural myeloma, Extraosseous, thoracic, Myelopathy, Decompression