A Woman With Back Pain

This is a 31-year-old female who was in excellent health until she developed vague intermittent low-back pain unrelated to activity, radiating into the right buttock and lateral thigh but without any other symptoms. PHYSICAL ExAmINATION The physical findings were significant only for focal midline tenderness over L2 vertebra. The neurological examination was within normal limits. LAbORATORY RESuLTS Alkaline phosphatase was elevated with normal serum calcium and phosphorus. All other laboratory studies were within normal limits. COuRSE Initial lumbar radiographs of the lumbar spine series revealed an “ivory vertebra ” of the L2 vertebra con-firmed by computed tomography (CT) scan and techne-tium bone scan positive only at L2. On admission, she underwent a spinal angiogram that was negative for abnormal blood flow at L2 and for any other abnormal-ity. A percutaneous Craig needle biopsy of L2 under flu-oroscopic control was performed for cultures and pathol-ogy. The histological examination revealed thickened bone trabeculae and prominent cement lines in mosaic pattern with increased osteoblasts and osteoclasts, con-sistent with Paget’s disease of bone. She was advised o