Paget's Disease of the Spine and Secondary Osteosarcoma

Abstract

This is a case of a 72-year-old male with a known history of Paget's disease with worsening back pain. Images from computed tomographic (CT) myelography performed 4 years prior to recent presentation demonstrate the characteristic appearance of Paget's disease of the spine with diffuse coarsened, thickened trabeculae and enlargement of the bone resulting in central canal stenosis (see Fig. 1). Selected images of the T12 vertebral body also demonstrate the characteristic appearance of Paget's disease to a slightly lesser degree than the more inferior L1 vertebral body (see Fig. 2). Fig 1 Axial CT image of the L1 vertebral body obtained postmyelography and viewed with bone windows obtained 4 years prior to recent presentation demonstrates the characteristic appearance of Paget's disease with thickened, coarsened trabeculae and ... Fig 2 Axial postmyelogram CT of the T12 vertebral body obtained 4 years prior to presentation demonstrates mild Pagetic involvement. Four years later, the patient presents with worsening back pain. High-resolution CT scanning of the spine demonstrates, at the T12 level, lytic destruction of the left margin of the vertebral body and pedicle with associated soft tissue involvement (see Fig. 3). Nuclear medicine bone scan demonstrates multifocal involvement of Paget's disease with characteristic increased radiotracer uptake and enlargement of the bones, as noted in the left femur, right hemipelvis, and spine (see Fig. 4). Fig 3 (a) Axial CT image of the T12 vertebral body at recent presentation at approximately the same level as in Fig. 2 (at the level of the celiac axis) demonstrates marked lytic destruction of the left margin of the vertebral body extending into the ... Fig 4 Nuclear medicine bone scan demonstrates characteristic Pagetic appearance with multifocal areas of increased radionuclide uptake and enlargement of the bone including the left femur, right hemipelvis, and spine. CT-guided biopsy of the T12 vertebral body was performed, given the change in morphology of the vertebral body. An 11-gauge Osteo-Site (Cook Inc., Bloomington, IN, USA) device was inserted coaxially over an 18-gauge discogram needle to obtain two core biopsies of bone and soft tissue (see Fig. 5). A diagnosis of osteosarcoma was made. Fig 5 Images from CT-guided biopsy of the T12 vertebral body demonstrate accurate needle placement into the abnormal Pagetic bone.