Hadgaonkar Shailesh, Patwardhan Shaunak, Bhilare Pramod, Sancheti Parag, Shyam Ashok
Department of Orthopaedic, Sancheti Institute of Orthopaedics and Research, Pune. Maharashtra. India.
J Orthop Case Rep. 2021 Oct;11(10):1-5. doi: 10.13107/jocr.2021.v11.i10.2440.
Paget's disease of bone (PDB) is a metabolic bone disease presenting as polyostotic or monostotic lesions of the spine. Although common in the Anglo-Saxon population, it is rare on the Indian subcontinent. Neurological complications though infrequent can be severe in pagetic spine.
We report a case of a polyostotic variant of PDB involving lumbar spine (L2 vertebrae), iliac bones, and femur presenting as chronic low back pain and neurological deficit, i.e., cauda equina syndrome. On initial workup, a diagnosis of PDB was made and given cauda equina compression with neurological deficit, posterior spinal decompression, and biopsy was performed. The histopathological evaluation confirmed the diagnosis and the patient was treated with bisphosphonates for 6 months, along with serial monitoring of alkaline phosphatase levels.
Through this case report, we hope to emphasize that PDB should be considered as a possible cause of neurological symptoms at presentation, especially in elderly patients. Also furthermore, early surgical intervention followed by bisphosphonates therapy can lead to favorable outcomes in such patients.
骨佩吉特病（PDB）是一种代谢性骨病，表现为脊柱的多骨或单骨病变。虽然在盎格鲁 - 撒克逊人群中常见，但在印度次大陆却很少见。神经并发症虽不常见，但在佩吉特病累及的脊柱中可能很严重。
我们报告一例多骨型PDB病例，累及腰椎（L2椎体）、髂骨和股骨，表现为慢性下腰痛和神经功能缺损，即马尾综合征。在初步检查时，诊断为PDB，鉴于存在马尾神经受压和神经功能缺损，进行了后路脊柱减压和活检。组织病理学评估证实了诊断，患者接受了6个月的双膦酸盐治疗，并定期监测碱性磷酸酶水平。
通过本病例报告，我们希望强调，PDB在就诊时应被视为神经症状的可能病因，尤其是在老年患者中。此外，早期手术干预后再进行双膦酸盐治疗可使此类患者获得良好预后。
