[Myeloma and epidural invasiveness. Clinical and therapeutic aspects (a study of 22 cases)]

The authors have retrospectively studied 22 cases of spinal cord compression among 184 patients having multiple myeloma or plasmocytoma. Neurological signs were the initial symptoms of the malignant plasmocytosis in 32% of the cases. Seven patients had paraplegia, 13 paraparesia and three had no motor involvement. A laminectomy was performed in half of the cases (with or without local radiotherapy and/or chemotherapy); the 11 other patients were treated by radiotherapy and/or chemotherapy alone. Sixteen patients (72%) improved, 10 in the laminectomy group and six in the other. The improvement seemed to be better after the laminectomy (and/or radiotherapy or chemotherapy) but to a lesser extend if the patients were paraplegic, in case of sudden onset and of compression at the thoracic level. The median of survival was 30 months. They emphasize the utility of magnetic resonance imaging for the diagnosis of epidural involvement before the occurrence of objective neurological complications.