Spinal cord compression in Paget's disease

Cartlidge, N.E.F.; McCollum, John P. K.; Ayyar, Ram D. A.

doi:10.1136/jnnp.35.6.825

Cited by 17 publications

(5 citation statements)

References 9 publications

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“…In our series, patients who demonstrated either partial or temporary improvement after laminectomy and were treated with further antipagetic medical treatment exhibited marked improvement of their symptomatology with sustained relief [50]. From our experience and from other reports, spinal surgery for pagetic spinal stenosis may fail to reverse the neurological deficit completely [15], and may be associated with serious complications such as a mortality rate of 11% [117] and dangerously profuse, if not torrential, bleeding [116]. To avoid such catastrophes, we recommend the preoperative assessment of bone vascularity by means of radionuclide bone blood flow in the affected spinal region.…”

Section: Treatment Of Spinal Stenosismentioning

confidence: 88%

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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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Section: Treatment Of Spinal Stenosismentioning

confidence: 88%

“…However, care should be taken not to confuse DISH with Paget's extraosseous bone formation [15]. The incidence of DISH in PD was reported to range from 14% [48] to 30% [5].…”

Section: Rheumatic and Arthritic Conditionsmentioning

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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“…Patients with stenosis in PDB can have a wide array of presentations with severe stenosis seen on imaging but present without clinical symptoms and patients with mild or moderate stenosis can present with back pain. The proportion of symptomatic patients with spinal stenosis ranges from 26 to 33% [ 2 , 9 , 12 ]. It is caused due to disturbance in the bone remodeling process which, in turn, leads to a subsequent decrease in the spinal canal size [ 1 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

A Polyostotic Paget’s Disease Involving Lumbar Spine Presenting with Cauda Equina Syndrome: An Unusual Entity

Hadgaonkar¹,

Patwardhan²,

Bhilare³

et al. 2021

JOCR

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Introduction:Paget’s disease of bone (PDB) is a metabolic bone disease presenting as polyostotic or monostotic lesions of the spine. Although common in the Anglo-Saxon population, it is rare on the Indian subcontinent. Neurological complications though infrequent can be severe in pagetic spine. Case Report:We report a case of a polyostotic variant of PDB involving lumbar spine (L2 vertebrae), iliac bones, and femur presenting as chronic low back pain and neurological deficit, i.e., cauda equina syndrome. On initial workup, a diagnosis of PDB was made and given cauda equina compression with neurological deficit, posterior spinal decompression, and biopsy was performed. The histopathological evaluation confirmed the diagnosis and the patient was treated with bisphosphonates for 6 months, along with serial monitoring of alkaline phosphatase levels. Conclusion:Through this case report, we hope to emphasize that PDB should be considered as a possible cause of neurological symptoms at presentation, especially in elderly patients. Also furthermore, early surgical intervention followed by bisphosphonates therapy can lead to favorable outcomes in such patients. Keywords:Polyostotic, Paget’s disease, cauda equine syndrome, lumbar spine.

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“…Cerebrospinal fluid protein may be elevated, without an increase in the number of cells. Myelography may show involvement of the spinal cord due to narrowing of the spinal canal; therefore, the opaque medium must be introduced by the cisternal route, above possible obstruction of the canal (22).…”

Section: Compression Of the Spinal Cord And Nerve Rootsmentioning

confidence: 99%

Paget's Disease and the Nervous System

Feldman

Culebras

Schmidek

1979

J American Geriatrics Society

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Paget's disease usually is found in patients past the age of 40. Early presenting symptoms include headache, deafness, tinnitus, and pain due to radicular compression. The diagnosis is confirmed by radiographic features and elevated levels of serum alkaline phosphatase and urinary hydroxyproline. Bony overgrowth results in pressure on nearby soft tissues such as the brain, spinal cord, and certain peripheral nerves. The abnormally soft quality of the calvarial bone permits distortion by the weight of the brain. Dorsal inclination of the plane of the foramen magnum and the projection of the odontoid process into the posterior fossa lead to stretching of the brain stem over the odontoid process and the ventral margin of the foramen. Obstructive hydrocephalus may result. Sarcoma of the cranial vault may develop in cases of Paget's disease. Once cervicomedullary or spinal compression has occurred, surgical decompression may be necessary. Three drugs—calcitonin, disodium etidronate, and mithramycin—have been used with some benefit in the treatment of Paget's disease.

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Spinal cord compression in Paget's disease

Cited by 17 publications

References 9 publications

Principles of management of osteometabolic disorders affecting the aging spine

Principles of management of osteometabolic disorders affecting the aging spine

A Polyostotic Paget’s Disease Involving Lumbar Spine Presenting with Cauda Equina Syndrome: An Unusual Entity

Paget's Disease and the Nervous System

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