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İstanbul Üniversitesi İstanbul Tıp Fakültesi, Nöroşirürji Anabilim Dalı, İstanbul A case of Paget's disease causing radicular pain and reduced muscle power is presented. MR imaging and therapeutic features are discussed. Excessive and uncontrolled bone reformation is imaged as decreased signal intensity in enlarged cortical areas on MR. The vertebra is flattened. The marrow is reduced and divided by connective tissue and is enhanced probably because of increased circulation and venous pooling. Surgical decompression is considered if Paget's disease of the vertebral column causes neural compression. We performed hemilaminectomy and foraminotomy to decompress the nerve root and for histological confirmation. Further root decompression is obtained by vertebral distraction by pedicle screw system, and osseous fusion is added. It is known that distraction improves the stenotic canal and foramen; besides internal fixation and fusion of the posterior elements reduce the pressure on the affected anterior and medial columns. Diffuse idiopathic skeletal hyperostosis has been reported in Pagetic patients and this may facilitate vertebral fusion. The patient benefited from the surgical procedure and remained asymptomatic during the follow-up under calcitonin treatment. Anahtar Kelimeler : Internal fixator, MR imaging, nerve root compression, Paget, surgery, therapy