Spine: in Paget's Disease

- 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

Paget disease of the spine.

Low back pain in Paget's disease of bone.

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, August 14, 2012 3:41 pm