Challenge of the Week / Spine / 03.12.2021

A 62-year-old male patient with a history of multiple myeloma presents with a 4-week history of midback pain. He does not have difficulty with ambulation or bilateral lower-extremity sensory dysesthesia or weakness. He has a normal gait and is normoreflexic. He does not have long tract signs. Cervical, thoracic, and lumbar spine magnetic resonance imaging (MRI) demonstrate a T8 metastatic epidural lesion without substantial effacement of the spinal cord. Which of the following is the best next step in management?
    • Operative decompression, biopsy, and stabilization, followed by radiotherapy
    • The patient has multiple myeloma with back pain but no neurologic compromise or cord compression on MRI. Radiation therapy is the next best step

 

    • Radiotherapy (RT)
    • RT is effective in achieving local control and improving survival in certain radiosensitive tumors, such as multiple myeloma and lymphoma

 

    • Palliative care unit
    • The patient has multiple myeloma with back pain but no neurologic compromise or cord compression on MRI. Radiation therapy is the next best step. It can provide local control, while chemotherapy can provide a survival benefit. This patient is not yet in need of palliative care alone

 

    • Intravenous zoledronate administration
    • The patient has multiple myeloma (MM) with back pain but no neurologic compromise or cord compression on MRI. Radiation therapy is the next best step. Administration of bisphosphonate medications can reduce the skeletal complications of MM, but this does not treat the lesion at T8

     

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