- See:
Pagets Disease:
- Discussion:
- Paget's disease involves spine, esp third and fourth lumbar vertebras, in up to
1/3 of affected patients, & lower thoracic vertebras in 20%;
- most patients have symptoms;
- localized pain can develop because of pathologic fracture w/ vertebral collapse,
spinal-canal stenosis, secondary to enlargement of the vertebra with
spinal-cord or nerve-root compression, epidural hematoma or fat ossification,
neoplastic transformation, coexistent osteoarthritis, or vascular steal syndrome;
- spinal deformity is usually kyphosis, caused by
compression fx;
- enlargement of the pedicles and laminae in combination with compression
fracture of the vertebral body can produce
spinal stenosis or nerve-
root compression in the neural foramina.
- Pathophysiology:
- intial phase of the disorder involves bone resorption by osteoclasts
which is followed by a vigorous osteoblastic response, producing
excessive, poorly organized, structurally weak, highly vascular
woven bone;
- finally, the bone becomes quiescent, with bony sclerosis and no evidence
of increased turnover of bone;
- in pts w/ pagets dz, look for increased alk phos levels, hydroxyproline,
and increased levels of urinary hydroxyproline;
- serum calcium, phosphorous, and acid phosphatase are normal;
- Differential Diagnosis of "Ivory Vertebra"
-
pagets disease (bone should be expanded)
-
multiple myeloma
- lymphoma
-
hemangioma (coarse markings)
-
metastatic disease
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Paget disease of the spine.
Low back pain in Paget's disease of bone.
