A retrospective study of 84 patients with Paget's disease of the spine revealed 9 who developed pagetic intradiscal invasion from the adjacent vertebral bodies. Two patients were asymptomatic. One patient had back pain, one had symptomatic intraforaminal stenosis without back pain, and five had clinical and radiologic spinal stenosis and spine pain; of these five, one demonstrated clinical and radiologic findings indistinguishable from spondylodiscitis. The incidence of intradiscal transgression in Paget's disease of the spine was 10.7%. Spinal pain was present in 67% patients; 22% were asymptomatic. This study shows that disc pathology is not invariably associated with spinal pain.