Surgical treatment in spine Paget’s disease: a systematic review

Jorge-Mora, Alberto; Amhaz-Escanlar, Samer; Iglesias, Ana; Leborans-Eiris, Susana; Pino, Jesús

doi:10.1007/s00590-015-1659-5

Cited by 18 publications

(8 citation statements)

References 17 publications

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“…Blood loss was estimated as 300ml (range 100-600ml) but the authors found no difference between blood loss in patients who had or had not received pre-operative treatment with etidronate (278ml vs. 315ml, p=0.32) (105). A systematic review conducted by Jorge-Mora and colleagues reviewed the effects of anti-Pagetic therapy on blood loss and other outcomes after elective spinal surgery in 17 case reports (106). The most common indications for surgery were spinal cord compression (n=8), spinal stenosis (n=6) and back pain (n=3).…”

Section: Effects Of Drug Treatment In Paget’s Diseasementioning

confidence: 99%

“…Jorge-Mora and colleagues (106) conducted a systematic review of patients undergoing surgical treatment of the spine in Paget’s disease and identified 17 studies all of which described single case reports. The commonest indication for surgery was spinal cord compression (n=8) spinal stenosis (n=6) and low back pain.…”

Section: Effects Of Non-pharmacological Treatments In Paget’s Diseasementioning

confidence: 99%

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Diagnosis and Management of Paget's Disease of Bone in Adults: A Clinical Guideline

Ralston

Corral‐Gudino

Cooper

et al. 2019

Journal of Bone and Mineral Research

140

169

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An evidence based clinical guideline for the diagnosis and management of Paget’s disease of Bone (PDB) was developed using GRADE methodology, by a Guideline Development Group (GDG) led by the Paget’s Association (UK). A systematic review of diagnostic tests, pharmacological and non-pharmacological treatment options was conducted which sought to address several key questions of clinical relevance. Twelve recommendations and five conditional recommendations were made but there was insufficient evidence to address eight of the questions posed. The following recommendations were identified as the most important. Radionuclide bone scans, in addition to targeted radiographs, are recommended as a means of fully and accurately defining the extent of the metabolically active disease in patients with PDB.Serum total alkaline phosphatase (ALP) is recommended as a first line biochemical screening test in combination with liver function tests in screening for the presence of metabolically active PDB.Bisphosphonates are recommended for the treatment of bone pain associated with Paget’s disease. Zoledronic acid is recommended as the bisphosphonate most likely to give a favourable pain response.Treatment aimed at improving symptoms is recommended over a treat-to-target strategy aimed at normalising total ALP in PDB.Total hip or knee replacements are recommended for patients with PDB who develop osteoarthritis in whom medical treatment is inadequate. There is insufficient information to recommend one type of surgical approach over another. The guideline was endorsed by the European Calcified Tissues Society, the International Osteoporosis Foundation, the American Society of Bone and Mineral Research, the Bone research Society (UK) and the British Geriatric Society. The GDG noted that there had been a lack of research on patient-focused clinical outcomes in PDB and identified several areas where further research was needed.

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Section: Effects Of Drug Treatment In Paget’s Diseasementioning

confidence: 99%

Section: Effects Of Non-pharmacological Treatments In Paget’s Diseasementioning

confidence: 99%

Diagnosis and Management of Paget's Disease of Bone in Adults: A Clinical Guideline

Ralston

Corral‐Gudino

Cooper

et al. 2019

Journal of Bone and Mineral Research

140

169

View full text Add to dashboard Cite

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“…Patients should be screened by a cardiologist, as the often hypovascularized bone in Paget’s disease can lead to increased cardiac output with impaired cardiac function, 2 , 17 , 36 which might be even aggravated due to the frequently observed excessive blood loss during surgery in patients suffering from Paget’s Disease. 15 , 16 To reduce the risk of excessive blood loss during surgery, some authors advocated the use of anti-Pagetic treatment such as bisphosphonates and calcitonin before elective surgery, 14 , 15 , 16 , 17 , 35 , 41 although there is currently insufficient evidence to support this recommendation. 39 In any way, surgeons should be prepared to react to increased blood loss with the use of a cell saver system and blood products readily available on standby.…”

Section: Discussionmentioning

confidence: 99%

Total elbow arthroplasty for elbow osteoarthritis associated with Paget's disease: A case report and review of literature

Hasler,

Riede,

Helmy

et al. 2024

JSES Reviews, Reports, and Techniques

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“…Sie merkten auch an, dass die Vorbehandlung den intraoperativen Blutverlust deutlich reduzierte und dass der geschätzte Blutverlust bei Patienten mit aktiver Paget-Krankheit höher war. Aber es wurden keine Informationen zum Blutverlust und zur Krankheitsaktivität gegeben 16 17 18 19 20 .…”

Section: Blutverlust Bei Elektiven Orthopädischen Eingriffenunclassified

Chirurgische Interventionen beim Morbus Paget

Kurth¹

2023

Osteologie

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ZusammenfassungDie orthopädisch – chirurgische Behandlung von Patienten mit einem Morbus Paget stellt eine Herausforderung dar.In der modernen orthopädischen Chirurgie stehen adäquate Verfahren zur Verfügung, um – korrekt eingesetzt – dem Patienten eine deutliche Reduktion seiner Beschwerden zu ermöglichen und die Lebensqualität zu verbessern. Die Hauptkomplikationen sind pathologische Frakturen, Deformitäten der befallenen Knochen und die frühzeitige Entwicklung einer sekundären Arthrose großer Gelenke.Für den Operateur zu beachten, dass dieses Patientengut mit einem erhöhten Risiko für intra- und postoperative Komplikationen einhergeht. Um die Komplikationsraten weitgehend zu minimieren bedarf es einer sorgfältigen präoperativen Planung mit Überprüfung des aktuellen Status der Grunderkrankung und möglicher präoperativer medikamentöser Intervention mittels Bisphosphonaten (evidenzbasiert Zoledronat 5 mg) zur Normalisierung des Knochenstoffwechsels. Auch muss eine umfassende klinische und radiologische Diagnostik durchgeführt werden, um mögliche Mitbeteiligungen angrenzender Skelettabschnitte frühzeitig zu erkennen und Operationen und Implantate planen zu können.Intraoperativ sind die Schwierigkeiten gekennzeichnet durch die erhöhte Vaskularisierung des betroffenen Knochens und die deutlich veränderte Knochenstruktur. Einem vermehrten Blutverlust kann durch eine rechtzeitig eingeleitete Bisphosphonat-Therapie wahrscheinlich vorgebeugt werden. Wegen des oft gleichzeitig vorliegenden sklerotischen und osteolytischen Knochens ist die Verwendung geeigneten Instrumentarien und besondere Sorgfalt bei der Implantation von Osteosynthesematerial und Endoprothesen geboten. Eine maligne Entartung sollte bei ausgeprägter Schmerzsymptomatik und Weichteilschwellung bis zu ihrem Ausschluss in Betracht gezogen werden und eine weitere Diagnostik eingeleitet werden.

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Surgical treatment in spine Paget’s disease: a systematic review

Cited by 18 publications

References 17 publications

Diagnosis and Management of Paget's Disease of Bone in Adults: A Clinical Guideline

Diagnosis and Management of Paget's Disease of Bone in Adults: A Clinical Guideline

Total elbow arthroplasty for elbow osteoarthritis associated with Paget's disease: A case report and review of literature

Chirurgische Interventionen beim Morbus Paget

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