Paget’s disease of the lumbar spine: decompressive surgery following 17 years of bisphosphonate treatment

Abstract

Background

We present a rare case of Paget’s disease (PD) with involvement of the lumbar spine over a period of 19 years. We discuss the diagnostic process to rule out alternative diagnoses and medical and surgical treatment strategies.

Case description

A 58-year-old man first diagnosed with PD in 1998 with solid involvement of the 4th lumbar vertebra has been undergoing periodic examinations over a period of 18 years. Since then, the patient has been treated conservatively with bisphosphonates. When conservative treatment options have been exhausted, surgery was indicated due to a progressively reduced ability to walk. Surgery with undercutting decompression via laminotomy was performed. PD was confirmed by biopsy. Bisphosphonate treatment was continued pre- and postoperatively. Follow-up examinations showed an improvement in clinical outcome measures.

Conclusions

Conservative treatment remains the gold standard for PD with spinal involvement. This patient had been asymptomatic on bisphosphonate therapy for almost 17 years, but presented with new onset back pain. In such cases, fracture and rare conversion into sarcoma must be ruled out, and biopsy should be performed even in the absence of signs of malignancy. Currently, there are no clear treatment recommendations available in the literature regarding cases of PD with expansive growth and involvement of the spinal canal causing neurologic deficits. Furthermore, laminectomy has been shown to cause complications in up to 27% of cases with the risk of early postoperative death. In contrast, extended laminotomy and undercutting decompression should be considered.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. 1.

    Corral-Gudino L, Tan AJ, Del Pino-Montes J et al (2017) Bisphosphonates for Paget’s disease of bone in adults. Cochrane Database Syst Rev 12:CD004956

    PubMed  Google Scholar 

  2. 2.

    Dell’Atti C, Cassar-Pullicino VN, Lalam RK et al (2007) The spine in Paget’s disease. Skelet Radiol 36:609–626

    Article  Google Scholar 

  3. 3.

    Hadjipavlou AG, Gaitanis LN, Katonis PG et al (2001) Paget’s disease of the spine and its management. Eur Spine J 10:370–384

    CAS  Article  Google Scholar 

  4. 4.

    Jorge-Mora A, Amhaz-Escanlar S, Lois-Iglesias A et al (2016) Surgical treatment in spine Paget’s disease: a systematic review. Eur J Orthop Surg Traumatol 26:27–30

    Article  Google Scholar 

  5. 5.

    Morales H (2015) MR imaging findings of Paget’s disease of the spine. Clin Neuroradiol 25:225–232

    CAS  Article  Google Scholar 

  6. 6.

    Pestka JM, Seitz S, Zustin J et al (2012) Paget disease of the spine: an evaluation of 101 patients with a histomorphometric analysis of 29 cases. Eur Spine J 21:999–1006

    Article  Google Scholar 

  7. 7.

    Poor G, Donath J, Fornet B et al (2006) Epidemiology of Paget’s disease in Europe: the prevalence is decreasing. J Bone Miner Res 21:1545–1549

    Article  Google Scholar 

  8. 8.

    Ralston SH (2013) Clinical practice. Paget’s disease of bone. N Engl J Med 368:644–650

    CAS  Article  Google Scholar 

  9. 9.

    Sofka CM, Ciavarra G, Saboeiro G et al (2006) Paget’s disease of the spine and secondary osteosarcoma. HSS J 2:188–190

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Nicolas Heinz von der Höh.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

All authors confirmed consent for publication.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hofmann, A., Opitz, S., Heyde, C.E. et al. Paget’s disease of the lumbar spine: decompressive surgery following 17 years of bisphosphonate treatment. Eur Spine J 27, 3066–3070 (2018). https://doi.org/10.1007/s00586-018-5751-5

Download citation

Keywords

  • Paget’s disease
  • Bisphosphonates
  • Lumbar stenosis
  • Neurogenic claudication
  • Spinal decompression