About the journal

Cobiss

Srpski arhiv za celokupno lekarstvo 2008 Volume 136, Issue 7-8, Pages: 419-422
https://doi.org/10.2298/SARH0808419V
Full text ( 358 KB)
Cited by


Spinal localization of Paget disease: Case report

Vukašinović Zoran (Institut za ortopedsko-hirurške bolesti 'Banjica', Beograd)
Slavković Nemanja ORCID iD icon (Institut za ortopedsko-hirurške bolesti "Banjica", Beograd)
Spasovski Duško ORCID iD icon (Institut za ortopedsko-hirurške bolesti 'Banjica', Beograd)
Slavković Slobodan (Institut za ortopedsko-hirurške bolesti 'Banjica', Beograd)

INTRODUCTION Paget disease, localized on thoracal vertebrae, presents a significant challenge in diagnostics and treatment. Presenting with progressive neurological symptoms, it has a broad differential diagnostic spectrum and requires additional radiological, neurological and endocrinological evaluation. Besides drug therapy, an operative decompression of nerve elements is performed when indicated. CASE OUTLINE We present a case of an older male patient complaining of chronic progressive pain localized at fourth and fifth thoracal vertebrae, with slight but progressive hypertonus and hyperreflection of leg muscles, including no plantar response. Vertebral biopsy indicated parathyreoid disturbance, excluded by further endocrinological analyses. At that point a corporectomy of fourth and fifth vertebrae and titanium cage spondylodesis of adjacent levels was performed, with pathological findings suggesting Paget disease. Postoperatively, there was initial significant neurological improvement; unfortunately, 2.5 years after the operation a relapse of the disease developed with gibbus deformity. Further treatment was surgical in two stages (first by decompression, and later by broad laminectomy), resulting in partial neurological recovery. CONCLUSION Spinal localization of Paget disease as a monoostotic form must be considered in all cases of progressive neurological impairment accompanied by biochemical disturbances in blood and urine, and with radiologically evident deformity, pathological fracture or neoplastic destruction of vertebra. A combination of medicamentous and surgical treatment should significantly improve neurological condition.

Keywords: Paget disease, thoracal vertebra, monoostotic disease, spinal stenosis

More data about this article available through SCIndeks