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Neurosurgery69 papers

Paget's disease-lumbar spine

Last edited: 4/14/2026

Overview

Paget's disease of the lumbar spine, though less common than primary degenerative conditions, involves abnormal bone remodeling leading to structural changes, pain, and potential neurological deficits. This summary focuses on diagnostic approaches and management strategies for degenerative changes in the lumbar spine, which may overlap with aspects relevant to Paget's disease.

Diagnosis

  • Clinical Presentation: Pain, stiffness, and neurological symptoms 4.
  • Imaging Studies: MRI and CT myelography provide detailed views of bone and soft tissue changes 136.
  • Upright CT Myelography: Offers unique insights into pathology of lumbar spine degenerative diseases 1.
  • Endplate and Bone Quality Assessment: MRI-based scores for endplate bone quality (EBQ) and vertebral body bone quality (VBQ) can predict adjacent segment degeneration 1013.
  • Biochemical Markers: Elevated inflammatory markers may correlate with complications post-surgery 12.

    • Management

  • Surgical Interventions: Decompressive surgery and fusion procedures (e.g., TLIF, PLIF) for severe cases 33637.
  • Minimally Invasive Techniques: MIS-TLIF with cement-augmented pedicle screw fixation shows efficacy, especially in osteoporotic elderly patients 14.
  • Postoperative Care: Monitoring for complications such as noninfectious fever and dural tears 525.
  • Functional Assessment Tools: Use of Oswestry Disability Index (ODI) and EQ-5D for outcome measurement, though preoperative ODI thresholds may not predict surgical success 1122.
  • Pain Management: Multimodal approaches to manage postoperative pain, reducing opioid reliance 1920.
  • Mindfulness-Based Interventions: Preoperative MBSR training may improve postoperative outcomes 1920.

    • Special Populations

  • Elderly Patients: Consideration of comorbidities and surgical risks; minimally invasive techniques may offer advantages 141828.
  • Comorbidities: Management of concurrent conditions like osteoporosis is crucial, especially in surgical planning 1428.

    • Key Recommendations

  • Utilize MRI and upright CT myelography for comprehensive assessment of lumbar spine degenerative changes 136 (Evidence: Strong).
  • Consider minimally invasive surgical techniques for decompression and fusion to minimize complications and improve outcomes in elderly patients 1425 (Evidence: Moderate).
  • Incorporate preoperative functional assessments like ODI and EQ-5D, but interpret with caution regarding surgical eligibility 1122 (Evidence: Moderate).
  • Implement multimodal pain management strategies to reduce postoperative opioid use 1920 (Evidence: Moderate).
  • Evaluate bone quality using MRI scores to predict adjacent segment degeneration post-fusion 1013 (Evidence: Moderate).

    • References

    1 Kawabata S, Akaike Y, Nagai S, Imai T, Takeda H, Ito K et al.. Distinctive features of upright CT myelography in patients with lumbar spine degenerative diseases. 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 2 Kitano T, Takahashi T, Kanematsu R, Inoue T, Sato S, Minami M et al.. Association between lumbosacral transitional vertebrae and adjacent segment disease after L4-5 lumbar interbody fusion. Clinical neurology and neurosurgery 2025. link 3 Alhabil B, Al-Azar A, Alroobi S, Awadallah H, Hammad M, Shaat S et al.. Clinical and safety outcomes of decompressive surgery for patients with degenerative lumbar spine disease in the Gaza Strip: a prospective study. Clinical neurology and neurosurgery 2025. link 4 Beyer F, Eysel P, Bredow J. The Diagnosis and Treatment of Degenerative Changes of the Lumbar Spine. Deutsches Arzteblatt international 2025. link 5 Li Y, Yang G, Fang T, Kong F, Yang P, Pi B et al.. Postoperative Noninfectious Fever in Degenerative Lumbar Spine Diseases: A Multivariate Logistic Regression Analysis. World neurosurgery 2025. link 6 Vilà-Canet G, Isart-Torruella A, Del Arco A, Manzano D, Rodriguez-Rubio D, Samper-Castellano M et al.. Cutibacterium acnes in lumbar spine, from skin to deep tissue. A colonization study. 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 7 Taka TM, Collins CE, Miner A, Overfield I, Shin D, Seo L et al.. The role of generative artificial intelligence in deciding fusion treatment of lumbar degeneration: a comparative analysis and narrative review. 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 8 Kraiwattanapong C, Chandrsawang I, Keorochana G, Rajinda P, Chanplakorn P, Leelapattana P et al.. A spontaneous anterior fusion of lumbar spine after posterolateral lumbar fusion with pedicle screw-plate system. BMC musculoskeletal disorders 2025. link 9 Yakdan S, Joseph K, A Ruiz-Cardozo M, A Plog B, T Yahanda A, Hafez D et al.. Clinically significant improvement in health-related quality of life (EQ-5D-5 L) after endoscopic spine surgery. 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 10 Yan F, Li M, Chen H, Zhang T, Li Z, Xu Y et al.. Research on the predictive efficacy of MRI-based endplate bone quality and vertebral body bone quality scores for adjacent segment degeneration after lumbar spinal fusion. 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 11 Issa TZ, Haider AA, Lambrechts MJ, Sherman MB, Canseco JA, Vaccaro AR et al.. Preoperative Oswestry Disability Index Should not be Utilized to Determine Surgical Eligibility for Patients Requiring Lumbar Fusion for Degenerative Lumbar Spine Disease. Spine 2024. link 12 Tuliakov V, Barkov O. Biomarkers of inflomation in the blood of patients with the degenerative lumbar spine disease and complications after transpedicular fixation. Wiadomosci lekarskie (Warsaw, Poland : 1960) 2024. link 13 Kuo CC, Soliman MAR, Baig RA, Aguirre AO, Ruggiero N, Donnelly BM et al.. Vertebral Bone Quality Score as a Predictor of Adjacent Segment Disease After Lumbar Interbody Fusion. Neurosurgery 2024. link 14 Chen TZ, Lu XJ, Wu DZ, Meng FF, Qin RJ. Efficacy of minimally invasive transforaminal lumbar interbody fusion plus cement-augmented pedicle screw fixation in the treatment of degenerative lumbar spine disease with osteoporosis in the elderly. European review for medical and pharmacological sciences 2023. link 15 van de Wijgert IH, de Groot JC, Rood A, Spruit M, Vissers KCP, Fenten MG et al.. Scoping review of early pain-related outcome domains and measurement instruments after degenerative lumbar spine surgery. Regional anesthesia and pain medicine 2023. link 16 Kieffer WKM, Don A, Field A, Robertson PA. Lordosis loss in degenerative spinal conditions. Spine deformity 2022. link 17 Voelker A, Schroeter F, Steinke H, Heyde CE. Degeneration of the lumbar spine and its relation to the expression of collagen and elastin in facet joint capsules and ligament flavum. Acta orthopaedica et traumatologica turcica 2022. link 18 Devin CJ, Asher AL, Archer KR, Goyal A, Khan I, Kerezoudis P et al.. Impact of Dominant Symptom on 12-Month Patient-Reported Outcomes for Patients Undergoing Lumbar Spine Surgery. Neurosurgery 2020. link 19 Chavez JL, Porucznik CA, Gren LH, Guan J, Joyce E, Brodke DS et al.. The Impact of Preoperative Mindfulness-Based Stress Reduction on Postoperative Outcomes in Lumbar Spine Degenerative Disease: 3-Month and 12-Month Results of a Pilot Study. World neurosurgery 2020. link 20 Yi JL, Porucznik CA, Gren LH, Guan J, Joyce E, Brodke DS et al.. The Impact of Preoperative Mindfulness-Based Stress Reduction on Postoperative Patient-Reported Pain, Disability, Quality of Life, and Prescription Opioid Use in Lumbar Spine Degenerative Disease: A Pilot Study. World neurosurgery 2019. link 21 Staartjes VE, Schröder ML. The five-repetition sit-to-stand test: evaluation of a simple and objective tool for the assessment of degenerative pathologies of the lumbar spine. Journal of neurosurgery. Spine 2018. link 22 Gvozdyev BV, Carreon LY, Graves CM, Riley SA, McGraw KE, Head RJ et al.. Patient-reported outcome scores underestimate the impact of major complications in patients undergoing spine surgery for degenerative conditions. Journal of neurosurgery. Spine 2017. link 23 Kim YE, Choi HW. Does stabilization of the degenerative lumbar spine itself produce multifidus atrophy?. Medical engineering & physics 2017. link 24 Blizzard DJ, Sheets CZ, Seyler TM, Penrose CT, Klement MR, Gallizzi MA et al.. The Impact of Lumbar Spine Disease and Deformity on Total Hip Arthroplasty Outcomes. Orthopedics 2017. link 25 Kamenova M, Leu S, Mariani L, Schaeren S, Soleman J. Management of Incidental Dural Tear During Lumbar Spine Surgery. To Suture or Not to Suture?. World neurosurgery 2016. link 26 Zhao X, Zhao J, Xie Y, Mi J. The Utility of a Digital Virtual Template for Junior Surgeons in Pedicle Screw Placement in the Lumbar Spine. BioMed research international 2016. link 27 Park BE. Surgical Treatment of Degenerative Lumbar Spine Disease in Rural Sub-Saharan Africa: A Retrospective Study of 450 Cases and Its Future Implications. World neurosurgery 2016. link 28 Oehme D, Goldschlager T, Rosenfeld JV, Ghosh P, Jenkin G. The role of stem cell therapies in degenerative lumbar spine disease: a review. Neurosurgical review 2015. link 29 Landi A, Gregori F, Mancarella C, Maiola V, Maccari E, Marotta N et al.. Lumbar spinal degenerative "microinstability": hype or hope? Proposal of a new classification to detect it and to assess surgical treatment. 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 2015. link 30 Kojima K, Asamoto S, Kobayashi Y, Ishikawa M, Fukui Y. Cortical bone trajectory and traditional trajectory--a radiological evaluation of screw-bone contact. Acta neurochirurgica 2015. link 31 Formica M, Berjano P, Cavagnaro L, Zanirato A, Piazzolla A, Formica C. Extreme lateral approach to the spine in degenerative and post traumatic lumbar diseases: selection process, results and complications. 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 2014. link 32 Shen X, Zhang H, Gu X, Gu G, Zhou X, He S. Unilateral versus bilateral pedicle screw instrumentation for single-level minimally invasive transforaminal lumbar interbody fusion. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 2014. link 33 Brandão S, Seixas D, Ayres-Basto M, Castro S, Neto J, Martins C et al.. Comparing T1-weighted and T2-weighted three-point Dixon technique with conventional T1-weighted fat-saturation and short-tau inversion recovery (STIR) techniques for the study of the lumbar spine in a short-bore MRI machine. Clinical radiology 2013. link 34 Mueller B, Carreon LY, Glassman SD. Comparison of the EuroQOL-5D with the Oswestry Disability Index, back and leg pain scores in patients with degenerative lumbar spine pathology. Spine 2013. link 35 Zagra A, Minoia L, Archetti M, Corriero AS, Ricci K, Teli M et al.. Prospective study of a new dynamic stabilisation system in the treatment of degenerative discopathy and instability of the lumbar spine. 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 2012. link 36 Tsahtsarlis A, Wood M. Minimally invasive transforaminal lumber interbody fusion and degenerative lumbar spine disease. 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 2012. link 37 Kim DH, Jeong ST, Lee SS. Posterior lumbar interbody fusion using a unilateral single cage and a local morselized bone graft in the degenerative lumbar spine. Clinics in orthopedic surgery 2009. link 38 Cloyd JM, Acosta FL, Ames CP. Complications and outcomes of lumbar spine surgery in elderly people: a review of the literature. Journal of the American Geriatrics Society 2008. link

    Original source

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      Distinctive features of upright CT myelography in patients with lumbar spine degenerative diseases. — Kawabata S, Akaike Y, Nagai S, Imai T, Takeda H, Ito K et al. 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)
    2. [2]
      Association between lumbosacral transitional vertebrae and adjacent segment disease after L4-5 lumbar interbody fusion. — Kitano T, Takahashi T, Kanematsu R, Inoue T, Sato S, Minami M et al. Clinical neurology and neurosurgery (2025)
    3. [3]
      Clinical and safety outcomes of decompressive surgery for patients with degenerative lumbar spine disease in the Gaza Strip: a prospective study. — Alhabil B, Al-Azar A, Alroobi S, Awadallah H, Hammad M, Shaat S et al. Clinical neurology and neurosurgery (2025)
    4. [4]
      The Diagnosis and Treatment of Degenerative Changes of the Lumbar Spine. — Beyer F, Eysel P, Bredow J Deutsches Arzteblatt international (2025)
    5. [5]
      Postoperative Noninfectious Fever in Degenerative Lumbar Spine Diseases: A Multivariate Logistic Regression Analysis. — Li Y, Yang G, Fang T, Kong F, Yang P, Pi B et al. World neurosurgery (2025)
    6. [6]
      Cutibacterium acnes in lumbar spine, from skin to deep tissue. A colonization study. — Vilà-Canet G, Isart-Torruella A, Del Arco A, Manzano D, Rodriguez-Rubio D, Samper-Castellano M et al. 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)
    7. [7]
      The role of generative artificial intelligence in deciding fusion treatment of lumbar degeneration: a comparative analysis and narrative review. — Taka TM, Collins CE, Miner A, Overfield I, Shin D, Seo L et al. 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)
    8. [8]
      A spontaneous anterior fusion of lumbar spine after posterolateral lumbar fusion with pedicle screw-plate system. — Kraiwattanapong C, Chandrsawang I, Keorochana G, Rajinda P, Chanplakorn P, Leelapattana P et al. BMC musculoskeletal disorders (2025)
    9. [9]
      Clinically significant improvement in health-related quality of life (EQ-5D-5 L) after endoscopic spine surgery. — Yakdan S, Joseph K, A Ruiz-Cardozo M, A Plog B, T Yahanda A, Hafez D et al. 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)
    10. [10]
      Research on the predictive efficacy of MRI-based endplate bone quality and vertebral body bone quality scores for adjacent segment degeneration after lumbar spinal fusion. — Yan F, Li M, Chen H, Zhang T, Li Z, Xu Y et al. 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)
    11. [11]
      Preoperative Oswestry Disability Index Should not be Utilized to Determine Surgical Eligibility for Patients Requiring Lumbar Fusion for Degenerative Lumbar Spine Disease. — Issa TZ, Haider AA, Lambrechts MJ, Sherman MB, Canseco JA, Vaccaro AR et al. Spine (2024)
    12. [12]
      Biomarkers of inflomation in the blood of patients with the degenerative lumbar spine disease and complications after transpedicular fixation. — Tuliakov V, Barkov O Wiadomosci lekarskie (Warsaw, Poland : 1960) (2024)
    13. [13]
      Vertebral Bone Quality Score as a Predictor of Adjacent Segment Disease After Lumbar Interbody Fusion. — Kuo CC, Soliman MAR, Baig RA, Aguirre AO, Ruggiero N, Donnelly BM et al. Neurosurgery (2024)
    14. [14]
      Efficacy of minimally invasive transforaminal lumbar interbody fusion plus cement-augmented pedicle screw fixation in the treatment of degenerative lumbar spine disease with osteoporosis in the elderly. — Chen TZ, Lu XJ, Wu DZ, Meng FF, Qin RJ European review for medical and pharmacological sciences (2023)
    15. [15]
      Scoping review of early pain-related outcome domains and measurement instruments after degenerative lumbar spine surgery. — van de Wijgert IH, de Groot JC, Rood A, Spruit M, Vissers KCP, Fenten MG et al. Regional anesthesia and pain medicine (2023)
    16. [16]
      Lordosis loss in degenerative spinal conditions. — Kieffer WKM, Don A, Field A, Robertson PA Spine deformity (2022)
    17. [17]
      Degeneration of the lumbar spine and its relation to the expression of collagen and elastin in facet joint capsules and ligament flavum. — Voelker A, Schroeter F, Steinke H, Heyde CE Acta orthopaedica et traumatologica turcica (2022)
    18. [18]
      Impact of Dominant Symptom on 12-Month Patient-Reported Outcomes for Patients Undergoing Lumbar Spine Surgery. — Devin CJ, Asher AL, Archer KR, Goyal A, Khan I, Kerezoudis P et al. Neurosurgery (2020)
    19. [19]
      The Impact of Preoperative Mindfulness-Based Stress Reduction on Postoperative Outcomes in Lumbar Spine Degenerative Disease: 3-Month and 12-Month Results of a Pilot Study. — Chavez JL, Porucznik CA, Gren LH, Guan J, Joyce E, Brodke DS et al. World neurosurgery (2020)
    20. [20]
      The Impact of Preoperative Mindfulness-Based Stress Reduction on Postoperative Patient-Reported Pain, Disability, Quality of Life, and Prescription Opioid Use in Lumbar Spine Degenerative Disease: A Pilot Study. — Yi JL, Porucznik CA, Gren LH, Guan J, Joyce E, Brodke DS et al. World neurosurgery (2019)
    21. [21]
      The five-repetition sit-to-stand test: evaluation of a simple and objective tool for the assessment of degenerative pathologies of the lumbar spine. — Staartjes VE, Schröder ML Journal of neurosurgery. Spine (2018)
    22. [22]
      Patient-reported outcome scores underestimate the impact of major complications in patients undergoing spine surgery for degenerative conditions. — Gvozdyev BV, Carreon LY, Graves CM, Riley SA, McGraw KE, Head RJ et al. Journal of neurosurgery. Spine (2017)
    23. [23]
      Does stabilization of the degenerative lumbar spine itself produce multifidus atrophy? — Kim YE, Choi HW Medical engineering & physics (2017)
    24. [24]
      The Impact of Lumbar Spine Disease and Deformity on Total Hip Arthroplasty Outcomes. — Blizzard DJ, Sheets CZ, Seyler TM, Penrose CT, Klement MR, Gallizzi MA et al. Orthopedics (2017)
    25. [25]
      Management of Incidental Dural Tear During Lumbar Spine Surgery. To Suture or Not to Suture? — Kamenova M, Leu S, Mariani L, Schaeren S, Soleman J World neurosurgery (2016)
    26. [26]
      The Utility of a Digital Virtual Template for Junior Surgeons in Pedicle Screw Placement in the Lumbar Spine. — Zhao X, Zhao J, Xie Y, Mi J BioMed research international (2016)
    27. [27]
      Surgical Treatment of Degenerative Lumbar Spine Disease in Rural Sub-Saharan Africa: A Retrospective Study of 450 Cases and Its Future Implications. — Park BE World neurosurgery (2016)
    28. [28]
      The role of stem cell therapies in degenerative lumbar spine disease: a review. — Oehme D, Goldschlager T, Rosenfeld JV, Ghosh P, Jenkin G Neurosurgical review (2015)
    29. [29]
      Lumbar spinal degenerative "microinstability": hype or hope? Proposal of a new classification to detect it and to assess surgical treatment. — Landi A, Gregori F, Mancarella C, Maiola V, Maccari E, Marotta N et al. 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 (2015)
    30. [30]
      Cortical bone trajectory and traditional trajectory--a radiological evaluation of screw-bone contact. — Kojima K, Asamoto S, Kobayashi Y, Ishikawa M, Fukui Y Acta neurochirurgica (2015)
    31. [31]
      Extreme lateral approach to the spine in degenerative and post traumatic lumbar diseases: selection process, results and complications. — Formica M, Berjano P, Cavagnaro L, Zanirato A, Piazzolla A, Formica C 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 (2014)
    32. [32]
      Unilateral versus bilateral pedicle screw instrumentation for single-level minimally invasive transforaminal lumbar interbody fusion. — Shen X, Zhang H, Gu X, Gu G, Zhou X, He S Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia (2014)
    33. [33]
      Comparing T1-weighted and T2-weighted three-point Dixon technique with conventional T1-weighted fat-saturation and short-tau inversion recovery (STIR) techniques for the study of the lumbar spine in a short-bore MRI machine. — Brandão S, Seixas D, Ayres-Basto M, Castro S, Neto J, Martins C et al. Clinical radiology (2013)
    34. [34]
      Comparison of the EuroQOL-5D with the Oswestry Disability Index, back and leg pain scores in patients with degenerative lumbar spine pathology. — Mueller B, Carreon LY, Glassman SD Spine (2013)
    35. [35]
      Prospective study of a new dynamic stabilisation system in the treatment of degenerative discopathy and instability of the lumbar spine. — Zagra A, Minoia L, Archetti M, Corriero AS, Ricci K, Teli M et al. 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 (2012)
    36. [36]
      Minimally invasive transforaminal lumber interbody fusion and degenerative lumbar spine disease. — Tsahtsarlis A, Wood M 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 (2012)
    37. [37]
      Posterior lumbar interbody fusion using a unilateral single cage and a local morselized bone graft in the degenerative lumbar spine. — Kim DH, Jeong ST, Lee SS Clinics in orthopedic surgery (2009)
    38. [38]
      Complications and outcomes of lumbar spine surgery in elderly people: a review of the literature. — Cloyd JM, Acosta FL, Ames CP Journal of the American Geriatrics Society (2008)
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