Sacral bone cyst treatment resulting in paraplegia

Description

A 50-year-old man with a stage 1 solitary right sacral plasmacytoma complained of a sharp, burning lower back pain with radiation into his right lower extremity which worsened with movement. He had initially undergone localised radiation therapy, but the pain did not resolve. Postradiation CT-guided biopsy showed persistence of malignant plasma cells, and he then underwent seven cycles of VRD (dexamethasone, lenalidomide and bortezomib) chemotherapy. After chemotherapy, an 18-fluorodeoxyglucose-positron emission tomography/CT scan showed a new area of uptake in the right sacral ala near the initial plasmacytoma. A subsequent CT-guided biopsy was non-diagnostic, and repeat imaging at the time of presentation showed no interval growth. The lesion was believed to be a residual cyst with inflammatory changes from radiotherapy. Examination revealed no neurological deficits. The patient's pain was thought to be secondary to the cyst (figure 1) and was not relieved with physical therapy, duloxetine...

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