Multidisciplinary nursing approach to D6 vertebral collapse secondary to multiple myeloma

T. Lucy Grace¹, R. Kasthuri², Esthar Rani³*

¹Nurse Educator, Kauvery Hospital, Tennur, Trichy, Tamil Nadu

²Senior Patient Safety Nurse, Kauvery Hospital, Tennur, Trichy, Tamil Nadu

³Nursing Superintendent, Kauvery Hospital, Tennur, Trichy, Tamil Nadu

Abstract

This article presents the clinical course and nursing management of a patient who underwent D6 laminectomy and transpedicular biopsy for spinal cord compression secondary to multiple myeloma. The case highlights the importance of early assessment, multidisciplinary collaboration, and comprehensive nursing care across pre-operative, intra-operative, and post-operative stages. Emphasis is placed on the nurse’s role in neurological monitoring, pain management, patient education, and discharge planning. This report reinforces the critical role of nurses in ensuring optimal outcomes in patients with spinal lesions and oncological complications.

Key words: D6 laminectomy; Transpedicular biopsy; Multiple myeloma

Introduction

Spinal cord compression due to vertebral pathology is a medical emergency requiring timely diagnosis and intervention. Among thoracic lesions, involvement of the D6 vertebra is clinically significant because compression at this level may lead to progressive motor weakness, sensory deficits, and autonomic dysfunctions. D6 laminectomy and transpedicular biopsy are important surgical procedures performed to decompress the spinal cord and obtain tissue for histopathological diagnosis. In this case, these procedures played a vital role in confirming multiple myeloma and initiating appropriate treatment. Nurses are essential members of the multidisciplinary team, contributing to assessment, patient preparation, monitoring, and continuity of care.

Clinical Examination

Motor power chart

	Right	Left
Muscles	5	5
Bilateral upper limb	5/5	5/5
Hand grip	100%	100%
Bilateral lower limb	0 /5	0/5

Sensory impairment – Nil

Bowel and bladder function – Normal (+) +; CBD (+)

Case presentation

A 42 years’ female was admitted with complaints of sudden-onset bilateral lower-limb weakness for two days. She had a history of low backache for one week, which had worsened over the last three days. She also reported a band-like sensation over the upper back and chest, accompanied by burning pain. She had a history of right shoulder pain on and off for 6 month There was no history of trauma, fever, bowel or bladder disturbances, and no known co-morbidities.

Diagnostic Workup

Blood Investigation

Hemogram
Hemoglobin	9.7 g/dl
WBC	148000 Cells/Cumm
Platelet	350000/cu.mm
Renal Function Test
Urea	43 mg/dL
Creatinine	1.41
eGFR	48 mg/Dl
Liver Function Test
Bilirubin	0.53 mg/Dl
SGOT	20 U/L
SGPT	17U/L
LDH	208 U/L
Albumin	3.2 g/dl
Globulin	6.4 g/dl
ESR	120 mm/1hr
Serum calcium	10.8 mg/Dl
PT	15.0 Seconds

MRI Whole Spine

Multiple focal lesions involving the vertebrae, sternum, pelvic bones and both femur with reduction in height of the D6 vertebra with disruption of the posterior cortex with retropulsion causing significant thecal sac and cord compression with altered signal intensity within it. – To consider: multiple bone secondaries.

18F – FDG PET/CT Report

It shows Metabolically active multiple lytic lesions involving almost entire skeleton with metabolically active soft tissue component in manubrium sterni, right fourth rib, left sixth rib and sacrum as described above – likely represents multiple myeloma. Recommend histopathological correlation. Bilateral minimal pleural effusion. No other metabolically active visceral lesions to suggest primary.

Echocardiogram

Normal chambers
No segmental wall motion abnormalities at rest
Normal LV function (EF -60%)
Normal mitral, aortic, tricuspid and pulmonary valves
Intact IAS, IVS
No intracavitary masses, thrombus, vegetations
No pericardial effusion.

The nature of the disease, prognosis, need for surgical intervention, further evaluation and observation were explained to the family. Cardiologist and nephrologist opinions were obtained. After anesthetic fitness and informed consent, the patient underwent D6 laminectomy and transpedicular biopsy.

Patient had anemia mild renal impairment, multiple bone lesion with elevated globulin levels finding a possible paraproteinemia. Hence multiple myeloma was favourring more than metastatic deposit from unknown primary so serum protein electrpphoresis (SPEP) serum free light chains (SIFE) Serum immune electrpphoresis (SIFE) were sent to confirm Multiple Myeloma.showed an elevated M-component.IgG kappa . Bone marrow aspiration and biopsy confirmed the diagnosis of multiple myeloma.

Post-Operative Course

The post-operative period was uneventful. Medical oncologist opinion obtained. The patient was suspected to have multiple myeloma based on imaging.

Laboratory investigations (SPEP, SIFE, SFLC)

Treatment was initiated with

S No	Drugs	Dose	Duration
1	Inj. Dexa	20 mg	IV for 3 days
2	Inj. Bortezomib	2 mg	Day 1 and Day 8
3	Zoledronic acid	4 mg	Monthly

The patient showed symptomatic improvement in pain. However, lower-limb weakness persisted. Supportive care included analgesics, antibiotics, PPIs and other medications.

Physiotherapy and incentive spirometry were continued. The surgical wound healed well. She was clinicaly stable hence she was prepared for discharge.

Condition at Discharge

Conscious and oriented
Obeying commands
Upper limb movement intact
Paraplegia (+)
Vitals stable
Tolerating oral diet
On CBD
Operated wound healthy

Advice on discharge

Neurosurgeon’s Advice

S. No.	Drugs	Dosage	Frequency	Durations
1.	Tab. Vertin	16 mg	BD	5 days
2.	Tab. Pregalin D	75+20 mg	OD	10 days
3.	Tab. Para	1gm	TDS	5 days

Medical Oncologist’s advice

S No	Drugs	Dose	Frequency	Duration
1	Tab. Ecosprin	75mg	OD	10 days
2	Tab. Acyclovir	400mg	BD	10 days
3	Tab. TRD MD	50mg	TDS	10 days
4	Tab. Perinorm	10mg	TDS	10 days
5	Tab. Pan D	40mg	OD	10 days

Nurses Role

1. Pre-Operative Nursing Care

The nurse assessed the patient’s neurological status, pain level and mobility.
The nurse ensured that the patient and family received adequate information regarding the surgery.
She verified pre-operative investigations and ensured completion of anesthetic fitness.
Emotional support was provided to the patient and family

2. Intra-Operative Assistance

The nurse assisted in shifting the patient to the operating room maintaining spinal precautions.
She maintained strict aseptic precautions.
The perioperative nurse coordinated with the surgical team and monitored the patient’s vital signs continuously.

3. Post-Operative Nursing Care

The nurse monitored vital signs, oxygen saturation, and neurological status regularly.
Pain levels were assessed, and analgesics were administered as prescribed.
The surgical wound was inspected for bleeding, infection, or discharge.
Intake–output charting was maintained.
The nurse provided spinal precautions, safe positioning, and pressure-area care.
She encouraged the patient to perform deep breathing exercises and assisted with incentive spirometry.
Early physiotherapy and limb exercises were supported to prevent complications.
The nurse educated the patient and family about disease condition, medications, and follow-up.

4. Discharge Nursing Care

Medication instructions were explained clearly.
The nurse taught the family regarding skin care, bladder care, bowel routine, and physiotherapy needs.
Warning signs requiring urgent medical attention were explained.
Follow-up appointments were scheduled, and continuity of care was ensured.

Conclusion

The patient showed encouraging improvement following D6 laminectomy and biopsy with stabilization of her condition and initiation of treatment for multiple myeloma. Her symptoms were better controlled, and she responded positively to supportive care. Consistent nursing assessment, timely interventions and rehabilitation support contributed significantly to her progress. With continued treatment and follow-up, the patient is expected to maintain further clinical improvement. On following after one-month post discharge she has regained lower limb power and she is able to stand with support and continuing treatment for mylema and regular physiotherapy.

This case highlights the importance of early spinal decompression to ensure good neurological recovery. Timely diagnostic workup and treatment initiation, combined with appropriate nursing care throughout the course of stay, helped ensure a better patient outcome.

Multidisciplinary nursing approach to D6 vertebral collapse secondary to multiple myeloma

Multidisciplinary nursing approach to D6 vertebral collapse secondary to multiple myeloma

T. Lucy Grace1, R. Kasthuri2, Esthar Rani3*

Nightingale Journals

T. Lucy Grace¹, R. Kasthuri², Esthar Rani³*