E-Case report
Multiple Myeloma T10-L2 Dr. med. Juan José Correa Gámiz
Dr. med. Francisco López Caba
![June-–-Dr.-Correa-Gamiz-&-Dr.-Lopez-Caba](https://neo-medical.com/wp-content/uploads/2021/02/June-–-Dr.-Correa-Gamiz-Dr.-Lopez-Caba.png)
Pre OP
![Vector](https://neo-medical.com/wp-content/uploads/2021/01/Vector-3.png)
Clinical Case – Multiple Myeloma
Dr. med. Juan José Correa Gámiz
Dr. med. Francisco López Caba
Hospital Virgen de La Luz, Cuenca
Cuenca CUENCA
Spain
![image17-38](https://neo-medical.com/wp-content/uploads/2021/06/image17-38.png)
![Rectangle-13](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-13.png)
![image18-40](https://neo-medical.com/wp-content/uploads/2021/06/image18-40.png)
![Rectangle-11](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-11.png)
![Rectangle-10](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-10.png)
![Rectangle-14](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-14.png)
Patient Information:
- 75-year-old male patient
- History of hypertension, diabetes mellitus, prostate cancer in remission
- Patient attended trauma consultations for omalgia, shoulder pain left side since 4 months, and lumbar pain, both with mechanical characteristics
- Patient reported fever, but no weight loss
- Percutaneous biopsy of the T12 vertebra diagnosed plasmacytoma
- Diagnosis by Multiple Myeloma after complementary hematological laboratory tests and PET-CT (uptake in proximal femurs, ischiopubic branches, left clavicle, left 3-4º rib arch).
![Rectangle-15](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-15.png)
Pre OP radiographs
- Radiograph shows a lytic lesion on the left scapula
![ligne-2b](https://neo-medical.com/wp-content/uploads/2021/01/ligne-2b-1.png)
Radiograph shows a lytic lesion on the left scapula
![ligne-2b](https://neo-medical.com/wp-content/uploads/2021/01/ligne-2b-1.png)
![image19-42](https://neo-medical.com/wp-content/uploads/2021/06/image19-42.png)
![pre-op-1](https://neo-medical.com/wp-content/uploads/2021/06/pre-op-1.png)
- At the thoraco-lumbar level, a slightly wedging of the upper endplate of T12 can be seen
- Scapular and lumbar MRI: showing lytic lesions in the left scapula and left side of T12 vertebra with involvement of the posterior wall and pedicle with spinal compression that does not generate clinical symptoms
![ligne](https://neo-medical.com/wp-content/uploads/2021/01/ligne.png)
Pre OP situation & Surgical planning:
- Mechanical lumbar pain without associated neurological symptom
- Instability classification scale (SINS): 13
- Decision to perform percutaneous fixation without arthrodesis given the absence of spinal compression and with the benefit of starting early radiotherapy treatment
- No alteration of the sagittal balance
Intra OP
![Rectangle-14](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-14.png)
Surgical procedure
- General anesthesia
- Percutaneous approach
- Fixation T10-L2
- Neo Pedicle Screw System™
- 8 x Ø6.0 x 45mm pedicle screws
- Skin closure of incisions with staples
- Time of surgery: 1h40
![New opening up](https://neo-medical.com/wp-content/uploads/2021/06/New-opening-up.jpg)
![Rectangle-15](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-15.png)
Post OP
Post OP outcomes
![post-op-1](https://neo-medical.com/wp-content/uploads/2021/06/post-op-1.png)
- No lumbar pain 2 days after surgery
- Ambulation without assistance, and with no pain
- No neurological symptoms
- Discharged from the hospital ward 48h after re-evaluation by the department of hematology
- Started chemotherapy and radiotherapy 7 days after surgery
- No surgical wound complications
![ligne-2b](https://neo-medical.com/wp-content/uploads/2021/01/ligne-2b-1.png)
Follow Up at 15 months
- At this time, 76 years old, with progress of the multiple myeloma despite the treatment with radio- and chemotherapy
- No back pain of mechanical characteristics
- No failure of the osteosynthesis material (pedicle screws or rods)
- The patient is followed biannually in an outpatient trauma clinic
![post-op-2](https://neo-medical.com/wp-content/uploads/2021/06/post-op-2.png)
Radiographs at 15 months postoperatively, coronal and sagittal views
![ligne](https://neo-medical.com/wp-content/uploads/2021/01/ligne.png)
Published with the approval of Dr. med. Juan José Correa Gámiz & Dr. med. Francisco López Caba