Patient C., 74 years.

Diagnosis: Plasmacytoma of L4 vertebra pathological compression fracture of vertebra L4. Kyphoscoliotic deformity of the lumbar region due to pathological fracture of L4.

Complaints of pain in the lumbosacral spine under static load, walking, irradiation of pain in his right leg, deformity of the spine. Pain started in March 2010. MRI (May, 2010) – signs of pathological compression fracture of L4 vertebral body (most likely due to a metastatic lesion). No past medical history of oncology. Histology of the Trephine biopsy of the L4 vertebra, revealed plasmacytoma.The patient had no neurological deficit, and was given conservative treatment – 5 courses of chemotherapy. After conservative treatment, pain regressed. However, by December 2010, the spinal deformity due to pathological fracture of the spine increased, which in turn led to decompensation of the previously-existing degenerative spine disease in a patient. Repeated MRI study (January 2011) revealed a reduction of the tumor of L4 vertebra, signs of degenerative diseases of the spine, the spinal column deformity. Patient was seen in department no. 18 and was hospitalized for surgery.

Examination. General condition was satisfactory. The patient did not have severe somatic pathology, all organs and systems were within the physiological norm. Orthopaedic status The patient moves independently but with a neurogenic limp. Full range of motion of the extremities . The spinal column is deformed with a deviation of the trunk forward and to the right with a left-sided lumbar scoliotic curve. Local tenderness over L4 vertebra.

Treatment. In connection with the effectiveness of conservative treatment of plasmacytoma, as well as the prevalence of clinical signs of decompensation of degenerative diseases of the spine, which developed due to the deformation of the spinal column due to the pathological fracture L4 vertebra, this was an absolute indication for surgical treatment. Transpedicular fixation Th10-L2-L5-S1-SISP, L3 vertebra osteotomy and decompression of neural structures was performed.

Postoperatively, there was a reduction in pain, regression of neurological symptoms in the form of increased muscle strength in the lower extremities. After surgery statics and biomechanics of the spine was restored.