Pamidronate Treatment of the Neurologic Sequelae of Pagetic Spinal Stenosis

Wallace, Elizabeth; Wong, Jencia; Reid, Ian R.

doi:10.1001/archinte.1995.00430160167017

Cited by 43 publications

(2 citation statements)

References 12 publications

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“…Patients presenting with neurogenic pain due to cord compression by expanded pagetic bone (Fig. 20) can also respond well to medical treatment with calcitonin and bisphosphonates [63]. Surgical decompression is rarely necessary in cord compression as stenosis and neural dysfunction in PD may respond to medical treatment alone [5].…”

Section: Pathological Complicationsmentioning

confidence: 99%

The spine in Paget’s disease

et al. 2007

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Paget's disease (PD) is a chronic metabolically active bone disease, characterized by a disturbance in bone modelling and remodelling due to an increase in osteoblastic and osteoclastic activity. The vertebra is the second most commonly affected site. This article reviews the various spinal pathomechanisms and osseous dynamics involved in producing the varied imaging appearances and their clinical relevance. Advanced imaging of osseous, articular and bone marrow manifestations of PD in all the vertebral components are presented. Pagetic changes often result in clinical symptoms including back pain, spinal stenosis and neural dysfunction. Various pathological complications due to PD involvement result in these clinical symptoms. Recognition of the imaging manifestations of spinal PD and the potential complications that cause the clinical symptoms enables accurate assessment of patients prior to appropriate management.

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Section: Pathological Complicationsmentioning

confidence: 99%

The spine in Paget’s disease

et al. 2007

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“…Pagetic fractures also occur through lytic lesions and so the demonstration of healing of these lesions with bisphosphonates 26 suggests that this fracture type will also be prevented. Some pagetic complications, such as paraplegia, are too rare to ever be the subject of trials, yet a body of case reports indicates that surgical management often has disastrous outcomes whereas bisphosphonates can be curative 35 . This hard-won clinical evidence must inform our patient management and not just be discarded because it is not a clinical trial.…”

Section: Recent Guidelinesmentioning

confidence: 99%

Recent advances in understanding and managing Paget’s disease

Reid

2019

F1000Res

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Paget’s disease is a condition which continues to challenge and surprise. The dramatic fall in its incidence over the last three decades has been an enormous surprise, as is the capacity of a single infusion of the potent bisphosphonate, zoledronate, to produce biochemical remission in 90% of patients, remissions which usually persist for many years and raise the possibility of a cure in some patients. However, challenges in its management remain. The trials carried out in Paget’s disease have almost always had biochemical indices as their primary endpoints. From these studies, we also know that bone pain is relieved, quality of life improved, bone histology normalised, and radiological lesions healed. Thus, disease progression is halted. Studies have not been powered to assess whether clinically important endpoints such as fracture and the need for joint replacement surgery are diminished, although these complications are well established as part of the natural history of the condition. Since disease progression is prevented by potent bisphosphonates, it is likely that disease complications will also be prevented. Zoledronate also reduces the frequency of follow-up needed and therefore provides a very cost-effective intervention in those who have symptomatic disease or are at risk of complications.

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