Surgical decompression in spinal Paget's disease: illustrative case.

Autor:	Price A; John Sealy School of Medicine, The University of Texas Medical Branch at Galveston, Texas.; Department of Neurosurgery, The University of Texas Medical Branch at Galveston, Texas., File C; John Sealy School of Medicine, The University of Texas Medical Branch at Galveston, Texas.; Department of Neurosurgery, The University of Texas Medical Branch at Galveston, Texas., Call-Orellana F; Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas., Andrade de Almeida RA; Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas., North RY; Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery. Case lessons [J Neurosurg Case Lessons] 2024 Jul 22; Vol. 8 (4). Date of Electronic Publication: 2024 Jul 22 (Print Publication: 2024).
DOI:	10.3171/CASE24203
Abstrakt:	Background: Paget's disease of bone (PDB) is a common bone metabolic pathology in older adults, characterized by mixed osteolytic, osteoblastic, and quiescent periods. Surgical guidelines for PDB involving the spine are not well-defined and are reserved for cases refractory to medical treatments, typically bisphosphonates like zoledronic acid. This case study describes a 52-year-old male with PDB who presented with rapidly progressing myelopathy symptoms refractory to standard medical treatment, warranting surgical decompression. Observations: Surgical decompression and fusion, involving laminectomy with partial facetectomies, placement of pedicle screw instrumentation, and posterolateral arthrodesis spanning beyond the pathological segment, was performed. Follow-up visits indicated progressive improvement in symptoms and mobility, and imaging showed stable postsurgical changes with increased sclerosis in the affected vertebrae on a 2-year postsurgical course. Lessons: This case underscores that PDB of the spine can transition from asymptomatic to significant impairment and demonstrates that surgical intervention can provide effective symptomatic relief in myelopathy secondary to PDB. The case contributes to the growing evidence of the effectiveness of surgical decompression in PDB involving the spine. https://thejns.org/doi/10.3171/CASE24203.
Databáze:	MEDLINE
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