The Occurrence in Osteitis Deformans of Lesions of the Central Nervous System, With a Report of Four Cases

Wyllie, W. G.

doi:10.1093/brain/46.3.336

Cited by 62 publications

(17 citation statements)

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“…Bone compression by the expanding pagetic vertebrae is by far the most common cause of neural dysfunction [46]; it was first reported by Wyllie in 1923 [136]. However, severe stenosis, as seen on computed tomographic (CT) scan, may remain asymptomatic, suggesting adaptability of the thecal sac and its neural elements to severe spinal stenosis without significant loss of function [124].…”

Section: Spinal Stenosismentioning

confidence: 99%

“…[Reprinted, with permission, from Lander P, Hadjipavlou A (1991) Intradiscal invasion of Paget's disease of the spine. Spine 16: [46][47][48][49][50][51] ment on the neural element [32,47,64,74,103,134,136], such as deprivation of blood supply to the neural elements by the rapidly remodeling hypervascular pagetic bone, which produces "arterial steal phenomenon".…”

Section: Spinal Stenosismentioning

confidence: 99%

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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: Spinal Stenosismentioning

confidence: 99%

Section: Spinal Stenosismentioning

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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“…This is attributed to the large size of the spinal cord in the thoracic and cervical regions relative to the capacity of the vertebral canal; therefore, the same proliferation of bone in all vertebrae would result in compression of the cervical and thoracic thecal sacs sooner than it would in the lumbar spine [145]. Involvement of the cervical and thoracic spine tends very often to predispose to clinical spinal stenosis with myelopathy [66] [81,143] Bone compression by the expanding pagetic vertebrae is by far the most common cause of neural dysfunction [66]; it was first reported by Wyllie in 1923 [169]. However, severe stenosis, as seen on computed tomographic (CT) scan, may remain asymptomatic, suggesting adaptability of the thecal sac and its neural elements to severe spinal stenosis without significant loss of function [145].…”

Section: Spinal Stenosismentioning

confidence: 99%

“…For example, patients with spinal cord symptomatology respond to calcitonin treatment better than patients with spinal nerve root lesions [32]; some patients experience progressive deterioration of neural function without evidence of myelographic block, which is not easily explained by mechanical effect alone [142]; neurologic signs do not always correlate with the site of skeletal involvement; and rapid clinical improvement occurs in some patients with medical antipagetic treatment alone. These observations suggest that neural dysfunction in PD may also result from mechanisms other than simple bone encroachment on the neural element [40,68,76,83,121,162,169], such as deprivation of blood supply to the neural elements by the rapidly remodeling hypervascular pagetic bone producing "arterial steal phenomenon." 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 [66].…”

Section: Spinal Stenosismentioning

confidence: 99%

Paget's Disease of the spine and its management

et al. 2001

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“…Spinal cord compression resulting from vertebral bony enlargement was first reported by Wyllie in 1923 (8), and myelopathy without anatomic obstruction due to presumed vascular steal has also been described (9). Therapeutic interventions for Paget's disease of the spine include treatment with mithramycin, calcitonin, and the diphosphonates, as well as surgical intervention.…”

mentioning

confidence: 99%

Clinical and radiographic improvement of bone of the second lumbar vertebra in paget's disease following therapy with etidronate disodium: A case report

Nicholas

Helfrich

Cooperstein

et al. 1989

Arthritis & Rheumatism

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Paget's disease of bone is most commonly seen in the spine; it may either be asymptomatic or may cause pain and neurologic impairment. We describe a patient with back pain due to Paget's disease of the second lumbar vertebra and spinal stenosis. The patient had a dramatic clinical and radiographic response to 2 courses of etidronate disodium, which was evidenced by resolution of the back pain and improvement in bony spinal stenosis. Etidronate may be effective in reversing bony spinal stenosis due to Paget's disease.

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The Occurrence in Osteitis Deformans of Lesions of the Central Nervous System, With a Report of Four Cases

Cited by 62 publications

References 0 publications

Principles of management of osteometabolic disorders affecting the aging spine

Principles of management of osteometabolic disorders affecting the aging spine

Paget's Disease of the spine and its management

Clinical and radiographic improvement of bone of the second lumbar vertebra in paget's disease following therapy with etidronate disodium: A case report

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