Surgical decompression in spinal Paget's disease: illustrative case
Anthony Price1,2, Christopher File1,2, Francisco Call-Orellana3
1John Sealy School of Medicine, The University of Texas Medical Branch at Galveston, Texas.
Journal of Neurosurgery. Case Lessons
|July 22, 2024
Summary
Paget
Area of Science:
- Orthopedic Surgery
- Neurosurgery
- Bone Metabolism
Background:
- Paget's disease of bone (PDB) is a prevalent metabolic bone disorder in older adults.
- Spinal PDB management guidelines are limited, with surgery reserved for treatment-resistant cases.
- A 52-year-old male with PDB experienced progressive myelopathy despite medical treatment.
Purpose of the Study:
- To present a case of spinal Paget's disease with refractory myelopathy.
- To evaluate the efficacy of surgical decompression and fusion for PDB-induced myelopathy.
Main Methods:
- Surgical decompression via laminectomy with partial facetectomies.
- Spinal instrumentation with pedicle screws and posterolateral arthrodesis.
- 2-year follow-up assessing symptom progression and imaging findings.
Main Results:
- The patient showed progressive improvement in neurological symptoms and mobility post-surgery.
- Imaging confirmed stable postsurgical changes and increased vertebral sclerosis.
- Surgical intervention effectively managed myelopathy secondary to spinal PDB.
Conclusions:
- Spinal Paget's disease can lead to significant neurological impairment.
- Surgical decompression and fusion offer effective symptomatic relief for PDB-related myelopathy.
- This case supports surgical intervention for advanced spinal Paget's disease.
