The patient is a known with long term polyarthralgia for more than 20 years with ESR and CRP all the time elevated. She started to complain of intrascapular pain with difficult breathing the last 2 months with progressing pain.

MRI dorsal spine done 5 days before her husband a doctor came to the clinic 03-February-2013 showing a picture of several involved spots in the dorsal spine with pathologic fracture of D3 with compression f the spinal cord mainly from the right, destroying the body of D3 and involving the lamina more the right side. There are minor changes at the D9 level.

On examination: the patient has pain both upper limbs (There is PCD C5-6 ) causing weak grip and extension both hands more the left with weak triceps both upper limbs 4/5. There is weak right leg - quadriceps 4/5, dorsi and planterflexion right foot 4/5. There is no sensory deficit.

Skeletonization of C7, D1-5. The left side of D3 costo-transvese structure was flail and full of tumor masses. Both laminae of D2 and D3 were tumorous and were removed to aid good decompression of the spinal cord. Drilling of the tumorous pedicle of D3 right side to remove all the visible tumorous masses. The histologic result was multiple myeloma. The soft mass of the tumor invading the D3 body was also removed and the spaces were filled by allograft. Using bended rods 20 cm length and 6 mm diameter, bended to adopt the natural double curve of the cervico-dorsal area, 4 Stryker large sublaminar hooks to D5 and D6 and 4 small to C7 and D1, fusion of C7-D1-D4 and D5 was achieved. Bone graft was aided lateral to the rods. The D4 lamina was omitted from fusion, because the lamina was week, that it cannot hold the device.

Routine closure of the wound. Smooth postoperative recovery.

The patient have the typical clinical picture of multiple myeloma. The surgery is not curative as plasmocytoma, but rather, to fix and decompress the spinal cord to prevent further neurologic deterioration.