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Paget's disease-cervical spine — Clinical Guidelines

Overview

Paget's disease affecting the cervical spine involves abnormal bone remodeling leading to deformities, pain, and potential neurological deficits. Surgical interventions such as anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are common treatments for symptomatic degenerative changes.

Diagnosis

Clinical Presentation: Neck pain, radiculopathy, myelopathy 1 4.

Imaging Studies: MRI for disc degeneration and spinal cord compression; CT or plain X-rays for bone abnormalities 1 6.

Bone Quality Assessment: Cervical Vertebral Bone Quality (C-VBQ) score predictive of complications 1.

Management

Surgical Interventions:

- Anterior Cervical Discectomy and Fusion (ACDF): Standard approach for disc herniations and spinal stenosis 1 4. - Cervical Disc Arthroplasty (CDA): Alternative to ACDF, potentially offering better functional outcomes and quicker return to work 2 10.

Postoperative Considerations:

- Predictive Factors for Outcomes: Preoperative C-VBQ score predicts adjacent segment degeneration 1. - Length of Stay: Influenced by patient comorbidities, surgical complexity, and institutional practices 5.

Special Populations

Obesity: Higher BMI may impact patient-reported outcomes and surgeon ratings negatively 13.

Twin Studies: Genetic factors significantly influence the development and surgical intervention rates for cervical spine diseases 3.

Key Recommendations

Utilize preoperative Cervical Vertebral Bone Quality (C-VBQ) scoring to predict complications such as adjacent segment degeneration 1 (Evidence: Moderate).

Consider cervical disc arthroplasty (CDA) over ACDF for younger, working-age patients to potentially improve return-to-work outcomes 2 (Evidence: Moderate).

Monitor and manage obesity preoperatively to potentially improve postoperative patient-reported outcomes and surgeon satisfaction 13 (Evidence: Moderate).

Evaluate patient genetic predispositions, particularly in twin studies, to tailor surgical approaches and predict disease progression 3 (Evidence: Weak).

References

1 Chen Y, Li Y, Fu X, Yang C, Wang Q, Wang G et al.. Preoperative Cervical Vertebral Bone Quality Score as a Predictor of Adjacent Segment Degeneration After Anterior Cervical Discectomy and Fusion: A Retrospective Study. World neurosurgery 2026. link 2 Perez-Albela A, Nassar JE, Thomson C, Shah I, Diebo BG, Daniels AH et al.. Return to Work After Anterior Cervical Disk Replacement Versus Fusion : A Systematic Review and Meta-analysis of Randomized Controlled Trials. Spine 2025. link 3 Holy M, Szigethy L, Wretenberg P, MacDowall A, Sigmundsson FG, Joelson A. Surgically treated degenerative cervical spine diseases in twins. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 2025. link 4 Klimko N, Danner N, Salo H, Kotkansalo A, Leinonen V, Huttunen J. Outcome After Anterior Cervical Decompression and Fusion-A Nationwide FinSpine Register Study of Independent Predictors of Outcome at 12 Months After Surgery for Degenerative Cervical Spine. Spine 2025. link 5 Moskven E, McIntosh G, Nataraj A, Christie SD, Kumar R, Phan P et al.. Factors associated with increased length of stay in degenerative cervical spine surgery: a cohort analysis from the Canadian Spine Outcomes and Research Network. Journal of neurosurgery. Spine 2024. link 6 Liang X, Liu Q, Xu J, Ding W, Wang H. Hounsfield Unit for Assessing Bone Mineral Density Distribution Within Cervical Vertebrae and Its Correlation With the Intervertebral Disc Degeneration. Frontiers in endocrinology 2022. link 7 Gordon AM, Golub IJ, Ng MK, Lam AW, Houten JK, Saleh A. Primary and Revision Cervical Disc Arthroplasty from 2010-2020: Patient Demographics, Utilization Trends, and Health Care Reimbursements. World neurosurgery 2022. link 8 Kotkansalo A, Leinonen V, Korajoki M, Korhonen K, Rinne J, Malmivaara A. Occurrence, Risk Factors, and Time Trends for Late Reoperations due to Degenerative Cervical Spine Disease: A Finnish National Register Study of 19 377 Patients Operated on Between 1999 and 2015. Neurosurgery 2021. link 9 Shi JG, Xu XM, Sun JC, Wang Y, Kong QJ, Shi GD. Theory of Bowstring Disease: Diagnosis and Treatment Bowstring Disease. Orthopaedic surgery 2019. link 10 Joaquim AF, Makhni MC, Riew KD. Evidence-based use of arthroplasty in cervical degenerative disc disease. International orthopaedics 2019. link 11 Chang H, Baek DH, Choi BW. Efficacy of Zero-Profile Implant in Anterior Fusion to Treat Degenerative Cervical Spine Disease: Comparison with Techniques Using Bone Graft and Anterior Plating. Journal of neurological surgery. Part A, Central European neurosurgery 2015. link 12 Ha KY, Kim YH, Ahn JH, Park HY. Factors Affecting Survival in Patients Undergoing Palliative Spine Surgery for Metastatic Lung and Hepatocellular Cancer: Dose the Type of Surgery Influence the Surgical Results for Metastatic Spine Disease?. Clinics in orthopedic surgery 2015. link 13 Auffinger B, Lam S, Kraninger J, Shen J, Roitberg BZ. The impact of obesity on surgeon ratings and patient-reported outcome measures after degenerative cervical spine disease surgery. World neurosurgery 2014. link 14 Hammerberg KW. Surgical treatment of metastatic spine disease. Spine 1992. link

Paget's disease-cervical spine