The spine in Paget’s disease

Abstract

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.

Imaging Findings and Evaluation of Metabolic Bone Disease

“…Paget's disease, largely asymptomatic, is often an incidental finding on radiography [59]. Radiography can help distinguish osteoblastic versus osteolytic lesions as well as demonstrate characteristic findings such as cortical thickening and tunneling, trabecular thickening, generalized bone enlargement, and deformities.…”

“…Of the vertebrae, the body is almost always involved with occasionally some posterior elements. The lumbar spine is the most frequently affected, followed by the thoracic and then cervical spine [59]. Paget's disease in long bones does not spread to adjacent bones but instead tends to envelope the original bone entirely if allowed to progress [60].…”

Advanced imaging of skeletal manifestations of systemic mastocytosis

“…Osteosclerosis has been associated with a more aggressive disease course [15]. Findings can be similar to those of idiopathic myelofibrosis [38], fluorosis [39], sickle cell anemia [29], Paget's disease [40][41][42][43], and renal osteodystrophy [44].…”

Vertebral involvement in Paget's disease: Morphological classification of CT and MR appearances

“…Vertebral body dimensions are normally intermediate between those of the suprajacent and infrajacent vertebras. The anterior and posterior heights of the vertebral body are not increased, since there is no periosteum/endosteum interface at the endplates [36]. In contrast, biconcave deformity of the vertebral endplates due to diffuse bone softening is common in advanced PD (Supplementary data, Fig.…”