Paget’s Disease of the Spine

Paget’s disease of bone (PDB) is a chronic metabolic disease due to the disturbance in the normal homeostasis of bone remodeling. The spine is the second most commonly affected part in the body. There is strong evidence that the prevalence of the disease is declining as is its extent and severity as well as patients are of increasing age at the time of diagnosis. Patients can be asymptomatic, and the disease may be incidentally discovered while other patients may have symptoms from the disease itself or as a result of its complications. Spinal changes due to PDB can be very difficult to depict on radiography and very subtle on MRI and may present a diagnostic dilemma. In fact, PDB may mimic other pathologies including neoplasia and may be incorrectly diagnosed as such. This is particularly important given that PDB usually affects elderly population in whom the risk of malignancy is already high. In this chapter, we discuss the epidemiological and pathological background of the disease and describe important practical radiological principles and imaging features that will assist in achieving a sound and confident diagnosis. The chapter also goes into details of potential complications in the spine.