Paget disease of the spine: CT with clinical correlation.

Zlatkin, M B; Lander, P; Hadjipavlou, A.; Levine, Josh

doi:10.1148/radiology.160.1.2940618

Cited by 54 publications

(34 citation statements)

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“…Back pain in PD may also be attributed to blood engorgement of the vertebral body caused by vascular and disorganized, hyperactive remodeling processes [90]. Other factors implicated in spinal pain may include invasion of the vertebral disc space by the pagetic process [90], and spinal stenosis [170]. We hypothesize that microfractures of the pagetic vertebral bodies, especially in the osteolytic or mixed phase, can also lead to back pain [66].…”

Section: Spinal Stenosismentioning

confidence: 98%

“…The spine is the second most commonly affected site in PD [4,33,82,105], predisposing patients to low back pain and spinal stenosis [6,72,76,170]. Hartman and Dohn [74] have shown that 15.2% of patients with PD had involvement of the vertebrae, and 26% of these patients had symptoms of spinal stenosis.…”

Section: Prevalence Of Back Pain and Spinal Stenosismentioning

confidence: 99%

“…3), by the expansion of the neural arch and the overgrowth of the facet joints, or by a combination of these [66,162,170] (Fig. 4).…”

Section: Prevalence Of Back Pain and Spinal Stenosismentioning

confidence: 99%

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Paget's Disease of the spine and its management

et al. 2001

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Section: Spinal Stenosismentioning

confidence: 98%

Section: Prevalence Of Back Pain and Spinal Stenosismentioning

confidence: 99%

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Paget's Disease of the spine and its management

et al. 2001

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“…The spine is the second most commonly affected site in PD [2,30,95], predisposing patients to low back pain and spinal stenosis [4,52,64,137]. Hartman and Dohn have shown that 15.2% of patients with PD had involvement of the vertebrae, and 26% of these patients had symptoms of spinal stenosis [59].…”

Section: Prevalence Of Back Pain and Spinal Stenosismentioning

confidence: 99%

“…15) [80], and spinal stenosis [137]. The authors hypothesize that microfractures of pagetic vertebral bodies, especially in the osteolytic or mixed phase, can also lead to back pain [46].…”

Section: Spinal Pain (Back Pain and Neck Pain)mentioning

confidence: 99%

Principles of management of osteometabolic disorders affecting the aging spine

Hadjipavlou

Katonis

Tzermiadianos

et al. 2003

European Spine Journal

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Osteoporosis is the most common contributing factor of spinal fractures, which characteristically are not generally known to produce spinal cord compression symptoms. Recently, an increasing number of medical reports have implicated osteoporotic fractures as a cause of serious neurological deficit and painful disabling spinal deformities. This has been corroborated by the present authors as well. These complications are only amenable to surgical management, requiring instrumentation. Instrumenting an osteoporotic spine, although a challenging task, can be accomplished if certain guidelines for surgical techniques are respected. Neurological deficits respond equally well to an anterior or posterior decompression, provided this is coupled with multisegmental fixation of the construct. With the steady increase in the elderly population, it is anticipated that the spine surgeon will face serious complications of osteoporotic spines more frequently. With regard to surgery, however, excellent correction of deformities can be achieved, by combining anterior and posterior approaches. Paget's disease of bone (PD) is a non-hormonal osteometabolic disorder and the spine is the second most commonly affected site. About one-third of patients with spinal involvement exhibit symptoms of clinical stenosis. In only 12-24% of patients with PD of the spine is back pain attributed solely to PD, while in the majority of patients, back pain is either arthritic in nature or a combination of a pagetic process and coexisting arthritis. In this context, one must be certain before attributing low back pain to PD exclusively, and antipagetic medical treatment alone may be ineffective. Neural element dysfunction may be attributed to compressive myelopathy by pagetic bone overgrowth, pagetic intraspinal soft tissue overgrowth, ossification of epidural fat, platybasia, spontaneous bleeding, sarcomatous degeneration and vertebral fracture or subluxation. Neural dysfunction can also result from spinal ischemia when blood is diverted by the so-called "arterial steal syndrome". Because the effectiveness of pharmacologic treatment for pagetic spinal stenosis has been clearly demonstrated, surgical decompression should only be instituted after failure of antipagetic medical treatment. Surgery is indicated as a primary treatment when neural compression is secondary to pathologic fractures, dislocations, spontaneous epidural hematoma, syringomyelia, platybasia, or sarcomatous transformation. Five classes of drugs are available for the treatment of PD. Bisphosphonates are the most popular antipagetic drug and several forms have been investigated. Keywords

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Malignant transformation in paget disease of bone

Hadjipavlou

Lander

Srolovitz

et al. 1992

Cancer

128

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Background. The previously reported incidence of malignant transformation of Paget disease up to 5.5% and its dismal prognosis have prompted the clinical investigation of a large population with Paget disease. Methods. A chart review of symptomatic and asymptomatic patients with a diagnosis of Paget disease between 1970 and 1985 at four large Montreal Hospitals revealed 1078 patients. Eight patients with malignant transformation were studied in detail. Results. The incidence of malignant transformation was 0.770, and the most frequent histologic type was osteogenic sarcoma. The most prevalent site was the femur, and pathologic fracture with focal osteolysis was present in 50% of patients at the initial appearance of the tumor. Healing at the fracture site was demonstrated in one patient. Another patient died of uncontrollable hemorrhage. A case of malignant lymphoma in Paget disease is recorded. Conclusions. Surgery or biopsy should be preceded by preoperative scintigraphic bone blood flow evaluation and, if necessary, administration of a preoperative course of mithramycin and selective embolization to minimize bleeding. The prognosis of malignant transformation in Paget disease is poor, although one patient with malignant lymphoma survived after aggressive treatment. Early biopsy and aggressive treatment should not be delayed.

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Paget disease of the spine: CT with clinical correlation.

Cited by 54 publications

References 0 publications

Paget's Disease of the spine and its management

Paget's Disease of the spine and its management

Principles of management of osteometabolic disorders affecting the aging spine

Malignant transformation in paget disease of bone

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