multiple myeloma accounts for 1% of adult malignancies and has an annual incidence of 3 to 4 per 100,000 persons in the united states , with a peak age of occurrence in the midsixties . multiple myeloma is a neoplasm of plasma cells characterized by monoclonal proliferation of plasma cells in bone marrow , infiltration of adjacent tissue and occasionally multiple organs , and production of an immunoglobulin ( usually monoclonal igg or iga ) . common presenting symptoms of multiple myalgia include bone pain ( especially back pain ) , fatigue ( typically caused by anemia ) , pathologic fracture , weight loss , paresthesia , and fever . minimally invasive surgical treatments such as vertebroplasty and kyphoplasty are effective and safe in the management of myelomatous vertebral fracture1,4,8 ) . in local recurrences , vertebroplasty can be executed before radiation therapy , thus synergizing its delayed analgesic action on pain11 ) . delayed injection of cement is safer and more effective in cases of osteolysis or fracture of the posterior vertebral wall2 ) . major spinal surgery is less effective in patients with multiple myeloma due to poor bone quality and median survival time . a 62-year - old male was admitted to the hospital with a lower back pain , pain in both lower extremities , and numbness that occurred 5 months earlier . he had slipped and fallen 2 months earlier and the back pain had since become aggravated . he had a history for hypertension , type 2 diabetes mellitus , angina pectoris , and asthma treated with oral medication . other than his erythrocyte sedimentation rate of 27mm / hr , c - reactive protein of 12mg / dl , and albumin level of 3.3 g / dl , the patient 's laboratory values on admission were normal . however , his hemoglobin was reduced from 16 to 12 g / dl 3 months later . radiographic studies including 1.5 tessler magnetic resonance imaging ( mri ) and computed tomography ( ct ) of his lumbar spine were performed on admission . mri and ct showed mild canal stenosis of l 4 - 5 , but other meaningful abnormal findings were not found ( fig . the spinal canal stenosis of l 4 - 5 existed in an mri of the lumbar spine conducted 2 years earlier , and there was no change in the degree of stenosis . we prescribed analgesics to relieve pain , and had no reason to suspect a secondary vertebral compression fracture . despite medication with analgesics for 2 months , the lower back pain was aggravated and the patient complained of gait difficulty due to back pain . an mri of the lumbar spine was performed again and showed an l1 compression fracture ( fig . 2 ) , and therefore , l1 vertebroplasty was performed ; however , patient 's pain did not improve . on an mri of the thoracolumbar spine taken one month later , t10 , l1 , and l3 compression fractures were shown , and on an mri of the whole spine 3 months later , t6 , t9 , t10 , l1 , l2 , l3 , l4 , and l5 compression fractures were shown ( fig . 3 ) . vertebroplasty of t9 , t10 , l2 , and l4 vertebral bodies ( fig . 4 ) and a bone biopsy of the t9 body were performed by vertebroplasty needle during the vertebroplasty procedure and the patient 's lower back pain was relieved . tumor markers ( cea , psa , ca 19 - 9 , ca-125 , and afp ) were demonstrated to be within normal range . on serum protein electrophoresis , an m - spike was present in the gamma globulin fraction , and the concentration of m - spike was 1.10 g / dl . serum immunoelectrophoresis and immunofixation electrophoresis revealed monoclonal gammopathy immunoglobulin a(iga ) , lambda type . on a quantitative immunoglobulin test , g / l ) , the iga level wa 16.1 g / l(normal range is 0.7 to 4 the above - mentioned results of bone biopsy , electrophoresis , immunoelectrophoresis , and immunofixation electrophoresis proved the diagnosis of multiple myeloma . the patient was referred to another hospital , where he received vad(vincristine , adriamycin , and dexamethasone ) chemotherapy 4 times and bone marrow transplantation . the mspike then decreased from 1.10 to 0.22 g / dl on serum protein electrophoresis . the patient is still alive without developing symptoms one year after diagnosis of multiple myeloma . primary osteoporosis is responsible for about 85% of vertebral compression fractures and the remaining 15% are associated with secondary osteoporosis and neoplasms13 ) . patients that suffer bone or back pain in spite of symptomatic treatment for more 2 - 4 weeks need further evaluation for multiple myeloma and other diseases , including polymyalgia rheumatica , hyperparathyroidism , vitamin d deficiency , and bone metastasis . in case of multiple myeloma , the laboratory findings usually show anemia , thrombocytopenia and neutropenia . also , the patients sometimes complain fatigue and depressive mood due to hypercalcemia . when we meet the compression fractures without hot uptake in bone scanning , more evaluations are needed . if multiple myeloma is suspected , for diagnosis , it is necessary to demonstrate m - proteins in either serum or urine , to prove the presence of 10% bone marrow clonal plasma cells , and to observe the clinical manifestations of the disease . the amount of myeloma cell mass can be predicted from the extent of bone lesions , the hemoglobin level , serum calcium level , and m - component levels in serum and urine . response to chemotherapy and patient survival are also significantly correlated with the measured myeloma cell burden3 ) . hematologic monitoring in multiple myeloma is based on determination of the serum and urine levels of paraprotein , albumin , hemoglobin , creatinine , and calcium . conventional radiological imaging is a method for staging multiple myeloma as well as for assessing complications of the skeletal system . both multidetector ct and mri are recommended for mid- and long - term monitoring5 ) . the combined use of multidetector ct and mri is also useful for initial staging of multiple myeloma10 ) . 1.5 tessler whole body stirmri can detect bone marrow infiltration in about 74% of multiple myeloma patients . moreover , whole - body mri showed a diagnostic accuracy superior to that of multislice computed tomography . in particular , the early stages of disease with less prominent osteolytic changes and diffuse infiltration patterns are more reliably visualized with the use of mri16 ) . the involvement of > 10 bone marrow focal points and diffuse infiltration on mri are more risky factors to predict vertebral fractures6 ) . both fdg - pet in combination with lowdose ct and whole - body mri are more sensitive than skeleton x - ray in screening and diagnosing multiple myeloma . however , whole - body mri is less suitable in assessing response to therapy than fdg - pet9 ) . vertebroplasty provides significant and long - lasting pain relief and reduces the risk of fracture or new collapse in contiguous vertebral bodies . vertebroplasty is an effective treatment that confers pain relief , enhanced mobility , and reduced use of medicine for all the stages of multiple myeloma associated with compression fracture12 ) . vertebroplasty was also confirmed in patients experiencing pain related to malignant spinal tumors with epidural extension , with a low complication rate15 ) . we should check for the possibility of pathologic vertebral fractures from multiple myeloma in non - osteoporotic compression fracture patients , especially when continuous fractures are present in relatively non - elderly patients , even though a history of trauma may exist . vertebroplasty is an effective method to relieve pain in cases of vertebral compression fracture due to malignancy .
multiple myeloma is a b - cell origin tumor characterized by hypercalcemia , osteolytic bony lesions , and pathologic fractures . 
 back pain is one of the most common presenting symptoms of multiple myeloma and about 60% of patients have vertebral involvement at the time of diagnosis7 ) . 
 minimally invasive surgeries such as vertebroplasty and kyphoplasty are effective to relieve pain and improve the quality of life when a compression fracture occurs in multiple myeloma patients . 
 we report a case of continuous multiple compression fractures associated with multiple myeloma . 
 we should check for the possibility of pathologic vertebral fractures resulting from multiple myeloma in non - osteoporotic compression fracture patients , and especially in cases of continuous fracture occurring in relatively non - elderly patients , even though a history of trauma may be present .