Paget's Disease of the spine and its management

Hadjipavlou, Alexander; Gaitanis, I.; Katonis, Pavlos; Lander, P

doi:10.1007/s005860100329

Cited by 70 publications

(83 citation statements)

References 134 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Others consider PD to cause back pain even more rarely [45]. However, in our population, 33% of patients with PD demonstrated pagetic involvement of the spine; 30% had clinical symptoms of spinal stenosis and 54% of these patients suffered back pain (24% attributed clearly to PD alone, 50% to degenerative changes and 26% to a combination of PD and degenerative changes) [46].…”

Section: Prevalence Of Back Pain and Spinal Stenosismentioning

confidence: 57%

“…Circumstantial evidence thus supports the plausible hypothesis that viral infection may trigger the onset of PD as well stimulate inheritable gene mutation. Future research hopefully will cast light on these issues [56].…”

Section: Etiologymentioning

confidence: 98%

“…Paget's disease of bone (PD), a mono-ostotic or polyostotic non-hormonal osteometabolic disorder, is postulated to be caused by a viral infection [10, 49,127]. This claim is supported by circumstantial evidence garnered from electron microscopic, immunologic, and epidemiologic studies [56].…”

Section: Etiologymentioning

confidence: 99%

“…Pagetic facet arthropathy is a major contributing factor to both back pain and spinal stenosis, and the more advanced the facet joint arthropathy, the greater the likelihood that patients will suffer clinical spinal stenosis and/or back pain [46]. However, this does not necessarily preclude that, though present, severe facet arthropathy may remain asymptomatic [46].…”

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

confidence: 99%

“…However, this does not necessarily preclude that, though present, severe facet arthropathy may remain asymptomatic [46]. Back pain in PD may also be attributed to blood engorgement of the vertebral body caused by vascular and disorganized, hyperactive remodeling processes.…”

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

confidence: 99%

See 4 more Smart Citations

Principles of management of osteometabolic disorders affecting the aging spine

Hadjipavlou

Katonis

Tzermiadianos

et al. 2003

European Spine Journal

Self Cite

View full text Add to dashboard Cite

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

show abstract

Section: Prevalence Of Back Pain and Spinal Stenosismentioning

confidence: 57%

Section: Etiologymentioning

confidence: 98%