Paraplegia Caused by Multifocal Osteosarcoma With Spinal Lesions

Background: Multifocal osteosarcoma is a rare condition that may be either synchronous or metachronous. Spine involvement of multifocal osteosarcoma is very rare. Synchronous multifocal osteosarcoma is typically described as the occurrence of tumors at two or more sites in the absence of pulmonary metastases. Methods: A 55-year-old man initially presented with low back pain. Multiple osteosclerotic lesions were observed, primarily in the spine and pelvis, as well as in soft tissues. Lung lesions were observed, but they were relatively small at reference. Laboratory tests showed a markedly elevated alkaline phosphatase (ALP) level of 36, 416 U/L (normal range, 115-359 U/L). Based upon a diagnosis of osteosarcoma on biopsy, chemotherapy was administered, resulting in a decrease in ALP to 17, 833 U/L. Results: Decompression of the symptomatic compressed spinal cord and posterior spinal stabilization of T8-12 were performed. However, progressive extensions of multiple lesions to the spinal canal led to paraplegia with urinary dysfunction. Eleven months after the first visit to our hospital, the patient died due to multiple organ failure. Conclusions: Multifocal osteosarcoma accompanied by spinal lesions may lead to paraplegia, a clinical problem that negatively affects the quality of activities of daily living. Level of Evidence 4. Clinical Relevance: Multifocal osteosarcoma accompanied by spinal lesions may lead to paraplegia, a clinical problem that negatively affects the quality of life and activities of daily living