Acute symptomatic calcific discitis in adults: a case report and review of literature

Abstract

Symptomatic calcific discitis has been reported in the paediatric population but is a rare entity in adults with only eight cases reported in the English literature. We present a case of adult calcific discitis presenting with acute onset back pain. Radiographs and CT demonstrated central T11-T12 disc calcification with diffuse marrow oedema on subsequent MRI. The patient was referred to our spinal oncology unit due to the extensive marrow oedema as a possible underlying primary bone tumour. Review of the CT confirmed an end-plate defect with herniated calcific nucleus pulposus with no underlying bone lesion. Features were in keeping with acute calcific discitis. The patient was treated symptomatically and made an uneventful recovery. We discuss the characteristic imaging features seen on radiograph, CT and MRI and review the current literature. Calcific discitis is a self-limiting pathology requiring symptomatic management only. Radiologists need to be aware of this rare entity as it can occur in adults and may be mistaken for a more sinister pathology such as infective discitis or a bone tumour and lead to further unnecessary imaging or invasive procedures.

Acute Symptomatic Calcific Discitis Mimicking a Septic Spondylodiscitis

“…However, in Case Reports in Rheumatology these cases, calcification usually involves several levels, including at least the annulus fibrosus. is contrasts with idiopathic CD which only affects the nucleus pulposus and where no underlying systemic condition is usually found [1].…”

“…Although it has been frequently reported in children, acute symptomatic CD is a rare condition in the adult population, with no more than 10 cases reported in the literature [1]. e real etiology of CD remains unclear, with multiple possible theories.…”

“…e most common hypothesis is the presence of a vascular insult, which could eventually lead to discal calcification by interrupting blood supply to the nucleus pulposus [10]. Repeated microtrauma might additionally play a role in this poorly understood process [1,11]. Disc calcifications have also been observed in ankylosis of the spine.…”

“…Acute symptomatic calcific discitis (CD) is a rare condition in the adult population, with very few cases reported in the literature [1]. Incident disc calcification is reported in 5% of chest radiographs and 6% of abdominal plain films, as well as in 70% of postmortem adult examinations [2].…”

“…Incident disc calcification is reported in 5% of chest radiographs and 6% of abdominal plain films, as well as in 70% of postmortem adult examinations [2]. However, these calcifications generally remain asymptomatic, but when they do manifest, they can induce acute onset severe spinal pain and stiffness, with imaging features mimicking infectious spondylodiscitis [1][2][3][4][5][6][7][8]. On the other hand, pyogenic spondylodiscitis can be extremely severe and is associated with high mortality rates ranging from 2 to 20% in the literature, which makes it a potentially life-threatening disease [9].…”