Case Presentation :

Diagnosis : Plasmocytoma of the entire C7 with circumferential involvement  and extradural compression with subsequent paraplegia.

 A 63 years old patient was transferred to Al-Shmaisani hospital 20.12.1999 complaining of neck pain, inability to move his lower limbs and gross weakness of the right hand . The patient was with cystofix  with bed sore at the sacral area . The patient started to complain of chest and lower neck pain 20.11.1999. Cardiac causes were sought , which were normal. 29.11.1999 the patient got severe abdominal pain  with difficulty of walking . The next day  the weakness progressed  and the patient became paraplegic. The patient was transferred to Al-Bashir hospital 30.11.1999.  MRI was performed  04.12.1999  showing the lesion of the C7 level.  Cystofix was inserted the first day of admission. The patient is not diabetic, nor hypertensive . He did not underwent previous surgeries.  He left smoking since 1975. Glaucoma for what receiving  cosmolol ED  for 1 year.  Eczema of both knees for 2 years. 1 year ago got neck pain with intrascapular pain for 1 week after lifting heavy object  and the pain disappeared completely.

On examination: The patient a gentle man with preserved higher functions . The cranial nerves were intact . the distal muscles of the right upper limb were weak 2/5 and complete paraplegia below D1 with anaesthesia. The deep reflexes were exaggerated both sides with Babinski present in both sides. The patient had bed sore at the sacral area.   

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Radiological  investigations before and after the operation.

The patient was operated 21.12.1999; In the supine position anterior approach to the cervical spine was performed and corporectomy of the tumorous C7 was done. The frozen section was that of plasocytoma. The disk material of the adjacent levels was removed and using the high speed drill a partial tunnel was created  to fit a compact bone graft harvested from the right fibular bone and fixed with 48 mm cervical miniplate with 8 screws of 20 mm length.  The wounds were closed and the patient repositioned prone and skeletonization of C5-D2 was done. The remnants of the tumor were removed and using Hartchell rectangle with  8 sublaminar wires the posterior elements, 2 laminae above and 2 laminae below were fixed. The tumor was totally extradural with intact dura. The wound was closed and 2 units of blood were transfused during the procedure.  

Postoperative course was smooth with rapid improvement of the neurological status. The patient could feel all toes both feet and could feel fullness of the bladder and he could void spontaneously the next postoperative day. The cystofix was removed and the patient could move his left lower limb and the weakness regressed within hours. The right lower limb started to improve , but with lesser degree . The patient could set down on the chair the third postoperative day. Control CT-scan and cervical X-rays were performed when necessary. The constructs and the screws were in acceptable position. The final histological verification was that of plasmocytoma. Bone marrow aspirate showed erythroblasts 34%, promyelocytes 4%, myelocytes 8%, metamyelocytes 7%, neutrophils 34%, lymphocytes 11%, plasma cells 1% and eosinophils 1%. M/E ratio was 1.6. Erythropoesis was normoblastic , myelopoesis unremarkable with no evidence of plasma cell proliferation. LDH was 651 U/L with Ca 7.6 MG/DL. The stitches in the neck were removed 29.12.1999 . The stitches in the right foreleg were removed after 1 week. The patient discharged  30.12.1999 to be seen and treated at the nuclear medicine. Radiotherapy was recommended to minimize the recurrence rate locally, but the patient disappeared to come after one year without performing the above mentioned recommendations. The patient underwent second surgery 1 year later for recurrence in the right lateral aspect of the tumor bed,  then sent to chemo and radiotherapy. He is till today of publication, neurologically free and recurrence free.

Published 23-06-2004

Revised : 18/10/2004 03:50:39