Magnetic resonance imaging presentation of lyric Paget's disease of the cervical spine

Abstract

Indications:1 patient with lytic Paget's disease of the cervical spine. Patients:One 74-year-old male European inpatient. TypeofStudy:A case report of a patient with Paget's disease of the cervical spine showing magnetic resonance imaging (MRI) features typical of neoplastic disease that responded to Aredia therapy. DosageDuration:90 mg daily infused iv for 2 weeks. Results:By day 5 of Aredia therapy, serum ALP levels significantly reduced from the admission level of 629 U/L to 382 U/L. The patient's neck pain also resolved. Treatment was continued with risedronate. AdverseEffects:No adverse events were mentioned. FreeText:The patient presented with neck pain of several weeks' duration. On physical examination, he had decreased range of motion in the neck and pain elicited on posterior cervical palpitation. No neurological deficits were noted. MRI of the cervical spine showed a diffuse lesion completely replacing the C2 and C3 vertebral bodies and showing signal intensity features typical of a neoplastic disease. Conventional radiographs confirmed an osteolytic process with the appearance of "ghost vertebrae" replacing the entire vertebral bodies of C2 and C3. Histological examination of the biopsy specimens taken from the C2 and C3 vertebral bodies revealed no evidence of malignant cells or infectious process, but there was interstitial fibrosis and focal metabolic activity, suggesting an early phase of Paget's disease of the cervical spine. The patient was started on Aredia. Other tests: serum alkaline phosphatase (ALP) level.