Pediatric intervertebral disc calcification: case series and systematic review of the literature

Abstract

Pediatric intervertebral disc calcification (PIDC) is an uncommon disease with an unclear etiology. The clinical picture may suggest a severe spinal disease, thus involving an extensive differential diagnosis. The aim of this study was to find a diagnostic and treatment approach for PIDC on the basis of the literature. The Medline, Embase, Web of Science, and Cochrane Systematic Review databases were searched for relevant studies, whose reference lists were checked manually for additional articles. For each study, year of publication, study design, demographics, onset type, history of trauma, clinical and neurological signs and symptoms, imaging studies performed, blood test results, treatment strategies, and outcomes were recorded. The charts of eight patients with symptomatic PIDC treated at our institution from 2000 to 2016 were reviewed. Of 1522 articles identified by the search, 51 level IV studies involving 91 patients fulfilled the inclusion criteria. Most patients were treated conservatively and achieved complete recovery. Of the 13 patients who were treated surgically, one had a persistent myelopathy at the final follow-up. All the patients of our case series were treated conservatively and achieved complete symptom resolution at the final follow-up. PIDC is predominantly a benign and self-limiting condition. Surgery should be considered only in case of failure of conservative treatment in the presence of severe neurological impairment and myelopathy. Level of Evidence: IV (case series and systematic review of level IV studies).

Regression of intervertebral disc calcification combined with ossification of the posterior longitudinal ligament: A case report

“…Disc calcification leads to a decrease in T2-weighted signal strength on MRI, which is considered an imaging manifestation of disc degeneration[ 14 ]. In children, calcification mainly affects the nucleus pulposus[ 15 ]. The presence of a calcified nucleus pulposus may affect the stress balance of the affected intervertebral disc, which leads to the nucleus pulposus protruding and compressing, stimulating and causing an inflammatory reaction within the posterior longitudinal ligament.…”

“…Physical examination can often reveal neck muscle spasms, tenderness at the lesion site, and limited neck movement. If there is nerve root or spinal cord compression, there may be corresponding signs of nervous system defects[ 12 , 15 ]. In the reported cases, the most frequently reported symptoms were neck pain.…”

“…We suggest that the following characteristics may be helpful for a preliminary diagnosis: local pain in the cervical or thoracic region, full or limited cervical motion, and high-density areas and ossified mass on DR and CT. MRI can be recommended to identify compression of the spinal cord. Generally, imaging findings are the main basis for diagnosis[ 15 ]. However, for this disease, there exists a possibility that the imaging performance and clinical symptoms are inconsistent[ 1 , 2 , 5 - 7 , 12 ].…”