- 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