Herniation of a calcified cervical disc into the foramen transversarium in an 8-year-old child

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

BACKGROUND

Intervertebral disc calcification (IDC) combined with ossification of the posterior longitudinal ligament (OPLL) in cervical discs is rarely reported. This case study presents a rare case of IDC combined with OPLL in the C2-C3 segment.

CASE SUMMARY

Here, we present a case of a 6-year-old Asian boy with severe neck pain and stiffness. Physical examination showed no neurological or other abnormalities. Digital radiography and computed tomography (CT) revealed a calcified intervertebral disc and OPLL at the C2-C3 vertebrae. The spinal canal compromise at C2-C3 was approximately 50% on magnetic resonance imaging. The final diagnosis was IDC combined with OPLL. We applied a neck brace for the patient to protect the neck. The patient's neck pain and stiffness recovered significantly within approximately 3 wk. At the 3 mo follow-up, the follow-up CT showed resolution of the ossified intervertebral disc herniation, and a small amount of calcification and slight OPLL remained at the involved segment.

CONCLUSION

IDC combined with OPLL is a relatively rare condition in children. However, the majority of patients could have a favorable outcome, and the ossified mass in the canal would be spontaneously resolved with conservative therapy.

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

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).

Intervertebral Disc Calcification and Klippel-Feil Syndrome

Intervertebral disc calcification is rare in the pediatric population and is associated with sudden neurological manifestations. Although commonly symptomatic, conservative management yields excellent prognosis in the vast majority of cases. The following case illustrates the finding of intervertebral disc calcification in a patient with vertebral body segmentation anomaly consistent with Klippel-Feil Syndrome. As both entities are associated with potential neurological sequelae, this case of coexistent pathologies highlights the importance of recognizing the potential presence of intervertebral disc calcifications in pediatric Klippel-Feil Syndrome patients.

Pediatric Idiopathic Intervertebral Disc Calcification: Single-Center Series and Review of the Literature

OBJECTIVE

To review pediatric idiopathic intervertebral disc calcification (PIIVDC) within a single center and within the literature to outline the disease course, management, and outcome.

STUDY DESIGN

A retrospective chart review was performed spanning the period between January 2001 and February 2016 for diagnoses of PIIVDC. Patient age, sex, symptoms, and history and physical and neurologic findings were reviewed. Laboratory and imaging findings, management, follow-up, and outcome also were studied.

RESULTS

Nine cases of PIIVDC were identified; they included 6 male and 3 female patients, with an age range of 23 months to 12 years. Two patients were asymptomatic, and PIIVDC was discovered incidentally. Of the remaining 7 patients, 5 presented with neck and/or back pain, 1 with painless torticollis, and 1 with painful torticollis. One patient reported neurologic symptoms of pain radiating along 1 dermatome. Disc spaces affected were 5 cervical, 4 thoracic, and 2 lumbar, with 2 patients having more than 1 space affected. All patients were managed conservatively. In 1 case, symptoms and lesions persisted after 5 years, but the remainder had complete symptom resolution, generally within 6 months.

CONCLUSIONS

The etiology of PIIVDC remains unknown but appears to occur spontaneously, without preceding trauma or underlying medical condition. A conservative approach to patients without severe neurologic deficit with outpatient follow-up is supported.

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

PURPOSE

The purpose of this case report is to present a very atypical case of cervical intervertebral disc calcification (IDC) with extreme lateral herniated calcification in a child. This is the first ever reported case in which T2-weighted signal intensity of the involved disc was restored to normal after a 2-year follow-up.

METHODS

A 10-year-old girl presented with neck pain and right upper limb numbness for 2 months. The initial computed tomography (CT) images on admission showed calcified nucleus pulposus with extreme lateral herniated calcification at the C6-C7 level. Meanwhile, T2-weighted magnetic resonance imaging (MRI) revealed decreased signal intensity of the involved disc. The patient was treated conservatively with nonsteroidal anti-inflammatory drugs and jaw-occipital belt traction for 2 weeks. The cervical CT and MRI scans were repeated at 2-year follow-up.

RESULTS

Her clinical symptoms were completely resolved after 2 weeks. At 2-year follow-up, CT and MRI images demonstrated that calcification was completely absorbed and T2-weighted signal intensity of the C6-C7 disc was restored back to normal.

CONCLUSION

Cervical IDC combined with extreme lateral herniated calcification is extremely rare in children. The recovery of signal intensity of intervertebral disc on MRI may provide further support to the feasibility of conservative treatment of IDC.

Idiopathic intervertebral disc calcification in childhood: an atypical case of an uncommon entity for pediatric pathologists

Calcification of the intervertebral disc is a common occurrence in the adult population, but it is rare in children. However, its radiological and clinical findings are well described in the pediatric age group, with close to 150 publications on record. In contrast, little information is available regarding the histological features of this entity, which may prove to be challenging to surgical pathologists. Here we provide a detailed description of a young patient with an inflammatory retropharyngeal mass originating in a calcified intervertebral disc. A review of the pathological features described in the literature in English, with pathogenic considerations, is presented.

Symptomatic cervical disc herniation in teenagers: two case reports

Introduction

The development of a symptomatic herniated cervical disc before the age of 20 is extremely rare. Sporadically reported cases of patients with cervical disc herniation under the age of 20 usually have had underlying disease.

Case presentation

Case 1: A 19-year-old Asian man visited our clinic and presented with progressive pain in his upper left scapula and weakness of the left deltoid and biceps brachii muscles. C5 radiculopathy by soft disc herniation at C4-C5 without calcification was diagnosed. Microsurgical posterior foraminotomy was performed and he recovered completely eight weeks after the surgery.

Case 2: A 15-year-old Asian man presented with difficulty in lifting his arm and neck pain on the right side. Neurological examination showed weakness of the right deltoid and biceps brachii muscles. A magnetic resonance imaging scan demonstrated a herniated intervertebral disc in the right C4-C5 foramen. The patient was treated conservatively and put under observation only, and had completely recovered eight weeks after admission.

Conclusion

Although extremely rare, symptomatic cervical disc herniations may occur even in the younger population under the age of 20 without any trauma or underlying disease. Favorable outcomes can be achieved by conventional treatments for cervical disc herniation.

Acute symptomatic intervertebral disk calcification in a child with retropharyngeal edema: computed tomography and magnetic resonance findings

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.

Idiopathic intervertebral disk calcification in childhood: a case report and review of literature

PURPOSE

Pediatric idiopathic intervertebral disk calcification (PIIVDC) is an uncommon entity affecting the intervertebral disks and adjacent vertebral body and musculoligamentous structures. More than 300 cases have been reported so far, but knowledge of PIIVDC is still fragmentary. The purpose of the study was to summarize the demographic and clinical characteristics of PIIVDC, and consider its treatment and natural history.

METHODS

This study is a review of 65 cases identified by literature search from 1990 to 2010.

RESULTS

Male-to-female ratio was 40:25. Most patients (83%) were aged 5-12 years. Muscle pain was the most common manifestation (71.9%), followed by sensorimotor disturbance (20.3%) and fever (13.8%). Torticollis or scoliosis were noted in 23.4% of patients, and 15.4% were asymptomatic. The cervical spine was most frequently affected (64.6%), followed by the thoracic (26.2%), cervicothoracic (10.8%), lumbar (4.6%), and thoracolumbar (1.5%) spine. The C6/7 intervertebral disk was most frequently affected (35.7%), followed by C3/4 (21.4%), C2/3 (17.9%), C5/6 (14.3%), and C4/5 (10.7%). Erythrocyte sedimentation rate was the most sensitive laboratory indicator. Conservative treatment was adopted for 89.2% of patients and surgery for 10.8%. Neurological outcome was excellent except for one patient.

CONCLUSIONS

PIIVDC appears to be a benign disorder associated with self-limiting inflammation. The natural history of PIIVDC will only be established by further experience with long-term follow-up periods into adulthood.

Intervertebral thoracic disc calcification associated with ossification of posterior longitudinal ligament in an eleven-year-old child

STUDY DESIGN

Intervertebral disc calcification of T6-T7, T7-T8 discs associated with ossification of posterior longitudinal ligament (OPLL) in a child is reported.

OBJECTIVE

To discuss the natural history and management of calcification of T6-T7, T7-T8 discs with OPLL.

SUMMARY OF BACKGROUND DATA

Calcified intervertebral discs are rare in children. Cervical disc calcification has already been described. However, thoracic disc calcification associated with OPLL has not been reported.

METHODS

An 11-year-old boy presented with progressive back pain for 6 months. Neurologic examination showed numbness in both lower extremities. The knee jerk reflex of the patient was hypertonic. The muscle strength of both lower extremities were Grade 4, with reduction. He was treated with a lumbar belt for 2 weeks.

RESULTS

Initial thoracic spine radiograph and CT scan showed two adjacent calcified discs of T6-T7, T7-T8 associated with T6-T7 OPLL, resulting in marked spinal canal stenosis. His neurologic symptoms subsided and his back pain disappeared after a 2-week conservative treatment. Three months later CT scan showed that the calcification of T6-T7, T7-T8 discs was aggravated, but the T6-T7 OPLL was relieved.

CONCLUSION

The natural history of intervertebral disc calcification is usually benign. In this case, the improvement of OPLL is associated with the stabilization of the maturely fused calcified disc. Spontaneous resolution of the OPLL and recovery of normal neurologic function can be expected with conservative treatment.

Thoracolumbar intervertebral disc calcifications in an 8-year-old boy: case report and review of the literature

An 8-year-old boy presented himself with a nontraumatic acute onset of thoracolumbar pain with an antalgic scoliosis. His past medical history did not reveal any infectious disorder. The back pain kept him from sleep and sports. Imaging revealed calcified intervertebral discs from thoracic intervertebral disc 10-11 to lumbar disc 2-3, with compression of the 11th thoracic root. Conservative treatment with analgesia, nonsteroidal anti-inflammatory drugs, and rest reduced the symptoms within a few days. The boy became asymptomatic within 2 weeks. Magnetic resonance imaging changes diminished in 2 months. Intervertebral disc calcification in children is a rare benign disorder which mostly affects the cervical spine. This is the first case, to our knowledge, of symptomatic intervertebral disc calcification involving the lumbar spine up to lumbar disc 2-3.

Cervical Radiculopathy Caused by Neural Foraminal Migration of a Herniated Calcified Intervertebral Disk in Childhood: A Case Report

Childhood intervertebral disk calcification is a rare clinical entity. Although its clinical course is usually benign, nerve root irritation or spinal cord compression can occasionally occur. We present the clinical and radiologic findings of a 9-year-old boy with cervical radiculopathy due to a herniated calcified intervertebral disk, which developed suddenly after swimming for 1 hour. Radiologic findings indicated that a calcified nucleus pulposus at the C6-7 level herniated into the spinal canal and migrated far into the right C6-7 neural foramen. Surgical management was performed 8 weeks after the onset of symptoms, because the initial presenting symptoms persisted despite conservative treatment. In children, calcified intervertebral disks can cause cervical radiculopathy that requires surgical management when they herniate and migrate far into the neural foramen.