Management of plasmacytomas of the spine

Epidural plasmacytoma often reflects systemic myelomatous involvement and usually has a poor prognosis. The isolated spinal plasmacytoma, however, is a lesion with the potential for long term remission or even cure in some cases. We report six patients with isolated plasmacytoma of the low thoracic or lumbar region, all of whom presented with pain and minimal neurological deficits. Our approach to such cases included a complete medical work-up and radiographic definition of the lesion with a bone scan, a skeletal survey, myelography, computed tomography, and, in some instances, spinal angiography. All of these patients underwent laminectomy and spinal fusion with autologous bone and Harrington rods. There was no morbidity associated with the procedure, which was designed to prevent possible collapse during subsequent radiotherapy or chemotherapy, with its attendant potential for neurological catastrophe. Several patients have developed systemic involvement necessitating chemotherapy, but in follow-up extending now to 4 years all patients remain ambulatory and pain-free. We are encouraged by the potential for symptomatic relief and neurological improvement of patients with isolated spinal plasmacytomas who are treated with an aggressive medical and surgical approach.