Acute Symptomatic Intervertebral Disk Calcification in a Child With Retropharyngeal Edema

Abstract

Intervertebral disk calcification in children is an uncommon self-limiting disease, which can cause symptoms like neck pain or torticollis, and can be treated with conservative management. The calcified disk material can herniate anteriorly, inducing dysphagia, or herniate posteriorly, causing neurologic symptoms secondary to spinal cord compression. We report computed tomography and magnetic resonance findings of a symptomatic intervertebral disk calcification at the C2-3 level with retropharyngeal edema caused by anterior herniation of calcified material in a 7-year-old boy.

Cervical intervertebral disc calcification with extreme lateral herniation in a child: T2-weighted signal intensity of the involved disc can be restored to normal

“…There was a rapid disappearance of the clinical symptoms in over 95 % of cases within a few weeks to several months [1,2,6,12]. In many cases, the resorption of calcification was complete within a few months to several years [3,4,[13][14][15]. According to the literature review of cervical IDC, the mean time of symptom resolution was 3 weeks (range 8 days to 3 months), and the mean time of calcification resorption was 11.5 months (range 3 months to 2 years), Table 1.The resorption of calcified disc may be due to the presence of some microvascular blood supply in the cartilage terminal plates and the anulus fibrosus in childhood [2,10,13,20].…”

“…Despite of several possible proposed factors such as trauma [1,4,6,15,18,19], infection [1,3,14,15], vascular nature [2,10,13,20], autoimmune disease [20], congenital anomaly [2,4,7], and metabolic diseases [2,4], the exact aetiology of IDC in children is still unclear [1][2][3][4][5][6].…”

“…Nevertheless, patients with cervical IDC frequently present with neck pain and occasionally associate with neurological deficit [1-3, 5, 9, 12, 15, 18], fever [6], torticollis [1,10,14,17] or dysphagia [1,8]. All cases of cervical IDC reviewed were symptomatic with neck pain, of whom 11 (57.9 %) had neurological deficit simultaneously.…”

“…The most likely reason for this condition is thought to be the presence and limitation of cervical uncovertebral joints. There are still many other associated changes including flattening, wedging and irregularity of adjacent vertebral body; increasing disc space; endplate sclerosis; ossification of posterior longitudinal ligament and pharyngeal edema [1,2,6,8,11,14,15,17,22].…”

“…The initial X-ray and computed tomography (CT) appearances of IDC showed high-density masses in the intervertebral space, while T2-weighted magnetic resonance imaging (MRI) revealed decreased signal intensity of the involved disc [3,[5][6][7][8][9][10][11][12][13][14][15][16][17]. The follow-up X-ray and CT images in most cases showed the resorption of calcification within a few months to several years [3,4,[13][14][15], but it has never been reported whether MRI signal intensity of the involved disc could be restored back to normal. In addition, IDC with posterior or anterior herniated calcification has been commonly reported in the literature [1-4, 6, 14, 17].…”