In spite of the fact that the spine is the second most common area affected by PD the majority of patients with PD remain totally asymptomatic. Some patients present with axial pain, which may be constant and does get better with rest. The pain may be ill-localized and of dull, boring character. Occasionally it may have a mechanical nature and increase on weight bearing.
Other patients may present with facet arthropathy or spinal stenosis. In the former group, as pagetic bone is formed next to the facet joint, it frequently leads to the development of osteoarthritis in that joint. This leads to pain that increases on weight bearing, may radiate to the buttock (never below the knee), and can be unilateral or bilateral. In the latter group, new bone formation leads to spinal stenosis, resulting in neurogenic claudication, radicular pain, and, at times, cauda equina syndrome or frank myelopathy. Acute back pain may develop when a fracture occurs in the pagetic bone.
The disease most commonly involves the pelvis, axial skeleton, and both femurs. When the skull is affected hearing loss may develop. A small fraction of patients (<1%) are at risk of developing sarcoma-tous transformation.
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