Primary Malignant Melanoma of the Lumbar Spine

Case Report

Austin J Orthopade & Rheumatol. 2017; 4(1): 1047.

Primary Malignant Melanoma of the Lumbar Spine

Mathew CJ¹, Karim F¹, Ali M²*, Katsigiorgis G¹, Lerman V¹ and Avanesov K¹

¹Department of Orthopaedic Surgery, Northwell Plainview Hospital, USA

²New York Institute of Technology College of Osteopathic Medicine, Old Westbury, USA

*Corresponding author: Muzaffar Ali, New York Institute of Technology College of Osteopathic Medicine, Northern Boulevard, Old Westbury, USA

Received: January 20, 2017; Accepted: February 13, 2017; Published: February 15, 2017


Low Back Pain (LBP) or Lumbago is a leading cause of disability in the United States. There are several etiologies including but not limited to muscle strains, discherniation, vertebral instability and fractures. Most serious however are metastatic neoplastic processes, which invade the spine, spinal cord, and nerve roots potentially causing significant neurologic and functional compromise. Primary tumors of the spine are extremely rare, even rarer are primary melanomas of the spine [1]. We present a rare case of a 55-year-old male that was admitted with unrelenting back pain and inability to ambulate. Imaging shows pathologic L3 vertebral body compression fracture, biopsy confirmed malignant melanoma. Clinical examinations from dermatology, gastroenterology, ophthalmology, and oncology confirmed that there were no primary sources of the malignancy identified resulting in the spinal lesion being the only source and location of the tumor [1]. The patient’s radicular symptoms and function improved post-operatively, patient was informed that data of his case will be submitted for publication. However, he later succumbed to a myocardial infarction two years later.

Keywords: Low back pain; Malignant melanoma; Computed tomography


Low back pain (LBP) is a leading cause of disability in the United States. LBP and its neurologic sequelae account for countless visits to emergency rooms and physician offices. Back pain can be as simple as a paraspinal muscle strain but can also be more complex, involving fractures and slippage of the vertebrae as well as herniated discs causing nerve root compression. Due to the common nature of back pain, it is often managed conservatively with physical therapy, antiinflammatory, anti-spasmodic and other analgesics. We present a unique case of LBP resulting from a malignant melanoma in the rare isolated site of the vertebral body.

Our patient was a middle-aged Caucasian male who presented to the emergency room with atraumatic severe low back pain and bilateral lower extremity weakness. Pathologic fracture of L3 vertebral body was noted and upon further work-up, a unique etiology of an isolated malignant melanoma was found within the vertebral body. After tumor resection and stabilization, the patient’s pain and mobility improved. We present this case to increase the awareness of atypical causes of LBP and to highlight the unique presentation of an isolated malignant melanoma arising within the vertebral body [2].

Case Presentation

A55-year-oldcommunity ambulating male with a significant past medical history of alcohol abuse, psoriasis and hypertension presented to the emergency room with a 3-day history of atraumatic low back pain and decreasing ability to ambulate. He denied any fevers or chills, recent weight loss or other constitutional symptoms. He denied any saddle paresthesias or loss of bowel or bladder control [2]. Due to his uncontrolled psoriasis, the patient frequently went to tanning salonsto control his outbreaks. On physical exam, he demonstrated no gross deformities, lesions or sores. He did present with lumbar paraspinal tenderness and spasm, with lower extremity weakness secondary to pain on bilateral hip flexion. He was intact to sensation to light touch in his bilateral lower extremities, with normal patellar, Achilles, Babinski and rectal tone reflexes and normal dorsalis pedis and posterior tibialis pulses. Upon presentation to the emergency department, radiographs of the lumbosacral spine revealed bony destruction at the endplates L3 with chronic deformation of the anterior aspect of the vertebral body (Figures 1).