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Minimally Invasive Approach of Lumbar Plasmacytoma: Case Report

Author(s): André Guimarães, Rita Sousa, Sara Neves, Pedro Teixeira Gomes, Luís Castelo

Solitary Bone Plasmacytoma is a subtype of Solitary Plasmacytoma characterized by a mass of monoclonal plasma cells with involvement of bony structures. This pathology presents a high risk of progression to Multiple Myeloma with systemic involvement. In vertebral involvement it can lead to lytic lesions with progression to vertebral collapse and instability. The clinical case is a female patient with no medical history, with a clinic of low back pain with evolution for more than 1 month, radiography showed wedge of L4 and computed tomography a lytic lesion of that level, was hospitalized for pain control and study. The Magnetic Resonance came to discard the compression of noble parts. She was admitted for surgery due to vertebral instability and minimally invasive L2-L3-L5 posterolateral fixation was performed with transpedicular bars and screws, tissue biopsy and decompression with L4 partial facetectomy laminectomy. Surgery was uneventful and the patient was discharged 3 days after a complementary study of the disease. After 1 month, the patient showed clear improvement in pain and after half a year, the fixation was stable without instability or deformities. The patient was followed up by Orthopedics and Hematology. Plasmacytoma is an uncommon neoplasm and the main symptoms are low back pain, as in the case described. Radiotherapy is the treatment of choice, however surgery has been growing as an adjuvant and clinical improvement. This case demonstrates a unique treatment, not previously described with a percutaneous fixation with good results.

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