title: [Spinal localization of Paget disease--case report].
abstract: BACKGROUND
  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 additio-nal radiological, neurological and endocrinological evaluation. Besides drug therapy, an operative decompression of nerve elements is performed when indicated.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.forename: Zoran
authors.initials: Z
authors.lastname: Vukasinović
authors.forename: Nemanja
authors.initials: N
authors.lastname: Slavković
authors.forename: Dusko
authors.initials: D
authors.lastname: Spasovski
authors.forename: Slobodan
authors.initials: S
authors.lastname: Slavković
mesh_terms: D006801:Humans; D008297:Male; D008875:Middle Aged; D010001:Osteitis Deformans / Q000175:diagnosis* / Q000601:surgery; D013122:Spinal Diseases / Q000175:diagnosis* / Q000601:surgery