• Kang-Un Kim, Joon Hyuk Choi, and Gun Woo Lee.
• Department of Orthopaedic Surgery, Armed Forces Capital Hospital, Sungnam.
• Medicine (Baltimore). 2018 Dec 1; 97 (50): e13374.

RationaleWe report on a patient with a positron emission tomography/computed tomography scans (PET/CT)-negative malignant spine tumor, which had even caused a pathologic fracture, and was eventually confirmed on surgical biopsy.Patient ConcernsA 67-year-old man visited our emergency department with sudden onset of lower extremities paraplegia after slip down. On examination, gradually increasing paralysis was observed in both lower limbs.DiagnosesPlain radiograph and CT showed an acute burst fracture at T12 with an osteolytic mass lesion within the vertebral body and pedicle, causing severe encroachment of the spinal canal. Magnetic resonance imaging (MRI) revealed a bulging posterior cortex of the T12 vertebral body, which suspected a pathologic fracture due to malignancy. However, PET/CT showed a benign burst fracture, which was confirmed by a senior radiologist.InterventionWe planned surgery for emergent decompression of the spinal cord, temporary stabilization, and tissue biopsy. The histologic evaluation confirmed the lesion to be a malignant solitary bone plasmacytoma (SBP). Seven days later, definite surgery in the form of pedicle screw fixation and posterolateral bone graft from T8 to L2 was performed. Four weeks after the definite surgery, the patient underwent radiation therapy for 2 months.OutcomesThree weeks postoperatively, lower extremity motor function fully recovered, and ambulation with support was possible. One year postoperatively, spine MRI showed no evidence of local recurrence, and complete decompression of the spinal cord was achieved.LessonsSpine surgeons should bear in mind that malignant spine tumors could be misinterpreted as benign on PET/CT.

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