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Multiple myeloma is characterized by clonal proliferation of plasma cells usually of the B cell type. The skeletal manifestations are usually osteolytic lesions whose differential diagnosis includes primary and secondary bone tumor. This tumor is characterized by the presence of abnormal paraprotein 8 in blood and urine. However, one to five per cent of the cases do not have any protein. Hence they are termed nonsecretory. It often poses a diagnostic dilemma when it is presented to orthopedic surgeons with no clear features of the disease. Our case report exemplifies such a diagnostic dilemma. A high index of suspicion must be borne in mind when excluding multiple myeloma as a cause of pain, pathological fracture or lytic lesion.

Study design: A case report of spontaneous resolution of a lumbar postdiscectomy pseudomeningocoele. Objectives: To suggest the role of nonoperative treatment even in symptomatic pseudomeningocoeles. Setting: Withybush General Hospital, Haverfordwest, Pembrokeshire, South Wales, UK. Case report: A 65-year-old lady underwent L4/L5 discectomy for lumbar disc prolapse in 1998. As the patient did not have relief of symptoms, an MRI was taken at 1 month following the operation, which showed a residual disc at L4/L5 and a pseudomeningocoele communicating with the subarachnoid space. The patient could not undergo further treatment because of the untimely demise of the surgeon. Over the next 3 months, the symptoms began to improve and the patient was totally asymptomatic and remained so for 3 years. In 2001, she was seen for a recurring leg pain and back pain and an MRI was done, which showed complete disappearance of the pseudomeningocoele but with recurrent disc lesion. Conclusion: Although the current medical literature favours re-exploration and repair of the dural defect in symptomatic pseudomeningocoele, the authors are of the opinion that conservative treatment may have a role in the treatment of the above condition as illustrated by the above example.

75 year old woman presented to the orthopaedic clinic with low back pain and left leg pain for last three months. The low back pain was of gradual onset and was progressive. The pain was aggravated on walking and standing. On clinical examination the patient was fit and well. She had bilateral free straight leg raise. Femoral nerve stretch test on the left leg was positive. She was intact neurologically and the range of movements in the spine were terminally restricted. Both hips and sacral iliac joints were clinically normal. A clinical diagnosis of lateral canal stenosis was made. Magnetic resonance imaging (MRI) of the lumbosacral spine revealed a well defined posterolateral extradural cystic mass (see fig 1). It had a low intensity wall signal and a high intensity content signal. Associated degenerative and spondylolisthetic spine was noted. The

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