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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.

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