A 71-year-old man with chronic low back pain. A, Lateral radiograph of the lumbar spine shows an enlarged L2 vertebral body with cortical and trabecular thickening (asterisk), with a presumed diagnosis of Paget disease. B, Sagittal T1-weighted MR image of the lumbar spine shows vertically oriented trabecular thickening and enlargement of the L2 vertebral body (asterisk). C, Fluoroscopic image during vertebral augmentation shows cement filling the L2 vertebral body. At the conclusion of the procedure, the patient reported complete resolution of back pain.