T2 vertebrectomy with combined anterior and posterior arthrodesis for treatment of a solitary plasmacytoma.

Background: Plasma cell neoplasmas are a heterogenous group of neoplastic tumor lesions occurring secondary to disordered proliferation of cells from a monocyte lineage. Plasmacytoma is a rare lesion that accounts for 5% of all plasma cell neoplasms. The current recommended treatment for solitary plasmacytoma is moderate dose radiation therapy. For patients who are suffering from axial back pain, spinal instability, radiculopathy, or bowel/bladder dysfunction secondary to spinal cord compression, surgical intervention with spinal decompression and stabilization can be used as an adjuvant to radiation therapy.

Case Description: We report a patient who presented with worsening axial and bilateral upper extremity pain. He was found to have a locally aggressive tumor involving the vertebral body of T2. After a repeat magnetic resonance imaging (MRI) and a computed tomography (CT)-guided biopsy, the diagnosis of a solitary plasmacytoma was confirmed. It destroyed over 90% of the T2 vertebral body, resulted in 22° of local kyphosis, and caused spinal cord compression. The tumor was treated with a T2 vertebrectomy, posterior arthrodesis from C5-T4, and anterior arthrodesis from T1-3.

Conclusions: Solitary plasmacytomas of the vertebral bodies are difficult lesions to treat secondary to their location and risk of neurologic compromise. Surgical intervention with tumor resection and adjuvant chemotherapy or radiation is the recommended treatment option.