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Other conditions in the elderly can cause spinal stenosis. Neurological complications are common in Paget's dis-

Fig. 6 a Lateral view of an enlarged Pagetic vertebra causing global stenosis. b Axial view

ease as the spine is one of the most common sites affected by the disease. The lumbar spine is involved in 50% of cases [12]. Enlargement of the vertebral body is common (Fig. 6), and this flattened body can compromise the integrity of the intervertebral foramina, interfere with the blood supply to the dura and nerve roots, or lead to spinal stenosis [26]. A single vertebra is usually involved; however, the frequency of neurological complications are rare compared with the high frequency of lumbar spine involvement in Paget's disease of bone. The vast majority of patients suffering of spinal Paget have no symptoms, yet when symptomatic, it is not necessarily at the level of Pagetic involvement. The Pagetic vertebra may favor disc prolapse, which in itself can cause nerve root entrapment. The increased vascularity of the Pagetic vertebrae may diminish the spinal cord or the nerve root blood supply, ultimately leading to a spinal artery steal syndrome [5]. The Pagetic process can involve the neural arches further reducing the diameter of the central or lateral canal.

Some cases of amyloidosis, associated with prolonged hemodialysis or amyloid tumors, and causing spinal stenosis or even cauda equina syndrome have been reported [15]. However, amyloid deposit in the ligamentum flavum have been reported in series of patients with spinal stenosis who did not present the amyloidosis conditions described higher. The presence and the abundance of those deposits are closely correlated to age [6]. The meaning of these deposits in the context of stenosis is, however, unclear. Rare cases of epidural gas leaks originating from the degenerative intradiscal space may cause compressive phenomena [13].

Fig. 7 Central stenosis above a fusion site. Fusion was performed with pedicular screws

of instrumentation (or even abuse of it) may cause stenotic situations. One of these conditions is degenerative deformity, usually scoliosis.

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