Seventy patients who had the radiographic features of Paget disease of the spine were evaluated clinically and with computed tomography, with the objective of correlation of the symptoms with the lesions. Of forty-five symptomatic patients, twenty-one had only pain in the back or neck and twenty-four patients had spinal stenosis with or without pain in the back or neck. Seven patients had a neurological deficit without pain, nineteen had so-called mechanical or arthritic pain, nine had pain that was attributable to the Paget lesion, and ten had a combination of the two types of pain. The most common cause of the spinal stenosis was expansion of bone that led to compression of the thecal sac and its neural elements. In one patient, the cord was compromised further by a pathological fracture of the eighth thoracic vertebra. There was a strong correlation between the presence of symptoms and the findings of spinal stenosis and arthropathy of the facets (zygapophyseal joints) on computed tomography. The spinal stenosis and the arthropathy of the facets were caused by the abnormal, hyperactive bone-remodeling, which resulted in the expansion of the osseous elements of the involved vertebra or vertebrae.