A 61-year-old white man presents with a history of recent lower extremity pain.
The patient was diagnosed with multiple myeloma 26 months before admission and subsequently received multiple rounds of chemotherapy, including neurotoxic bortezomib and vincristine. He reports increasing bilateral lower extremity pain beginning roughly 6 months earlier, described as burning and numbing in nature. He also complains of severe sensitivity of the plantar aspect of his feet, making ambulation difficult. He has been evaluated by a neurologist and underwent an electromyographic (EMG) scan that demonstrates a mixed peripheral neuropathy and lumbar radiculopathy. Spinal magnetic resonance imaging (MRI) demonstrates multilevel lumbar degeneration. The neurosurgical consult states that the patient is not an operative candidate because of his diffuse disease. In addition, he has a history of cardiomyopathy.