CAUDA-EQUINA SYNDROME WITH PAGETIC VERTEBRAL FUSION - CLINICAL RECOVERY UNDER CALCIUM VITAMIN-D SUPPLEMENTATION PLUS CLODRONATE AFTER APPARENT FAILURE OF PAMIDRONATE AND ACQUIRED-RESISTANCE TO ETIDRONATE
F. Eulry et al., CAUDA-EQUINA SYNDROME WITH PAGETIC VERTEBRAL FUSION - CLINICAL RECOVERY UNDER CALCIUM VITAMIN-D SUPPLEMENTATION PLUS CLODRONATE AFTER APPARENT FAILURE OF PAMIDRONATE AND ACQUIRED-RESISTANCE TO ETIDRONATE, Revue du rhumatisme, 64(7-9), 1997, pp. 495-499
A patient with an osteolytic L2-L3 pagetic block and pagetic lesions o
f L1 and the sacrum seen only as increased radionuclide activity becam
e resistant to etidronate after the fifth course (5 mg/kg/d six months
per year) and developed severe cauda equina syndrome (reduction in wa
lking distance to 30 m and sphincter dysfunction) due primarily to ver
tebral hypertrophy, Five months after a ten-day course of intravenous
pamidronate (22.5 mg/d), the clinical symptoms were unchanged, althoug
h the alkaline phosphatase level was down 50%, Oral clodronate (1600 m
g/day for six months per year) in combination with calcium and vitamin
D supplementation dramatically improved the walking distance and sphi
ncter disorders, Resolution of the neurological manifestations was com
plete after the second clodronate course, At last follow-up nine month
s after the fourth clodronate course, there was no evidence of a relap
se and the alkaline phosphatase level was normal, The time course of e
vents in this patient does not allow to affirm that pamidronate was in
effective and suggests that calcium and vitamin D supplementation impr
oved mineralization of the pagetic block and enhanced the effect of bi
sphosphonate therapy.