Acute calcific discitis or symptomatic calcified schmorl's node of the upper thoracic spine in an adult: A case report and literature review

Abstract

We describe a patient with acute calcific discitis following symptomatic Schmorl's node (SN) of upper thoracic spine. A 28-year-old female suffered from sudden severe pain in mid-thoracic, left scapular area, radiating to her chest. Plain radiography of the thoracic spine showed calcification in T3–4 intervertebral disc space. Computed tomography (CT) scan and magnetic resonance imaging (MRI) of the spine demonstrated calcification of the T3–T4 nucleus pulposus, migrating into the inferior of T3 vertebral body with reactive bone marrow edema. By conservative treatment with multidrug therapy, the pain subsided and disappeared in 3 months. Follow-up CT scan and MRI of the thoracic spine confirmed complete resolution of calcified SN and reactive bone marrow edema.

Calcific Discitis Seems to be a Common Incidental Finding in Adults

“…Sometimes follow-up imaging shows a resolution of the calcifications. 2 To the best of our knowledge, the prevalence of calcific discitis in adults has not been studied previously.…”

“…Calcific discitis seems to be a rare cause of back pain in adults, with around 40 published cases. 1 2 Imaging shows a calcification of the nucleus pulposus with extension through the endplates on computed tomography. This can be accompanied by bone marrow edema on magnetic resonance imaging.…”

“…Calcific discitis is more prevalent in the thoracic spine. 2 The prognosis is favorable and pain usually resolves with symptomatic treatment. Sometimes follow-up imaging shows a resolution of the calcifications.…”

Two Case of Symptomatic Schmorl's Node: A Case Report and Literature Review

“…경피적 척추체 성형술은 미세 골절 부위 에 시멘트 삽입을 통해 척추체에 물리적인 장벽을 형성 하며, 척추감압술은 수핵에 가해지는 축성 압력을 분산 시켜 척추체로의 원심성 압력을 감소시켜 수핵의 척추 체로의 추가적 탈출을 방지한다. 두 번째는 통증 완화 로, 쉬모를 결절의 자연 경과에서 급성기의 증후성에서 만성기의 비증후성으로 발달되는 과정을 인내하게 하 는 것이며, 신경차단술8,20,21) , 항염증제제요법22,30) 과 물리요법 23) 이 이에 해당한다. 신경차단술은 척추체 주위에서 통각 수용을 담당하는 방척추 신경(sinuvertebral nerve) (TNF-α)를 억제하는 치료법으로 infliximab을 투여하는 치료법이 활용되고 있다.…”