Thirty-six patients with pagetic involvement of the spine were evaluated clinically and by computed tomography (CT). Pagetic phase, modeling expansion, degree and site of spinal stenosis, and pagetic facet joint arthropathy were recorded for each involved vertebral segment. CT demonstrated spinal stenosis in 20 patients, 11 of whom exhibited spinal stenosis on plain films. Twenty-one patients had symptoms of neck or back pain, with associated neurologic dysfunction in 13. Spinal stenosis was present in 81% of the symptomatic patients and 20% of the asymptomatic patients. Severe pagetic facet arthropathy was present in 17 of the symptomatic patients. We conclude that spinal stenosis is an important cause of vertebral pain and neurologic dysfunction.