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Ye C, Shi M, Xie D, Wu H, Chen Q, Yang L. A rare case of intervertebral disc calcification combined with ossification of the posterior longitudinal ligament in a child: a case report and literature review. BMC Musculoskelet Disord 2024; 25:118. [PMID: 38336663 PMCID: PMC10854027 DOI: 10.1186/s12891-024-07218-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/20/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Intervertebral disc calcification (IDC) combined with calcification in children has been sporadically reported, while ossification of the posterior longitudinal ligament (OPLL) in the cervical spine in pediatric patients is exceedingly rare. The aim of this study is to investigate the potential prognosis and outcomes associated with this condition. CASE PRESENTATION We present an unusual case involving a 10-year-old Chinese child diagnosed with calcified cervical disc herniation and ossification of the posterior longitudinal ligament. Conservative treatment measures were implemented, and at the 1-month and 6-month follow-up, the patient's pain exhibited significant improvement. Subsequent cervical MRI and CT scans revealed the complete disappearance of OPLL and substantial absorption of the calcified disc. During the three-month follow-up, CT demonstrated slight residual disc calcification, however, the patient remained asymptomatic with no discernible limitation in cervical motion. CONCLUSIONS We conducted a comprehensive review of several cases presenting with the same diagnosis. It is noteworthy that IDC combined with OPLL in children constitutes a rare clinical entity. Despite imaging indications of potential spinal canal occupation, the majority of such cases demonstrate complete absorption following conservative treatment, with OPLL exhibiting a faster absorption rate than calcified discs.
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Affiliation(s)
- Cheng Ye
- Department of Orthopaedics, Spine Center, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
| | - Mingliang Shi
- Department of Orthopaedics, Spine Center, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
| | - Dong Xie
- Department of Orthopaedics, No. 905 Hospital of PLA Navy, Shanghai, China
| | - Hao Wu
- Department of Orthopaedics, Spine Center, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
| | - Qing Chen
- Department of Orthopaedics, Spine Center, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
| | - Lili Yang
- Department of Orthopaedics, Spine Center, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China.
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Chen K, Chen X, Su Y. Is conservative treatment a good choice for pediatric intervertebral disc calcification in children? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:3324-3329. [PMID: 36309875 DOI: 10.1007/s00586-022-07417-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 09/22/2022] [Accepted: 09/29/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Paediatric intervertebral disc calcification (PIDC) is a rare disease, and its aetiology remains unknown. This study aimed to analyse the characteristics and clinical outcomes of patients with PIDC. METHODS After applying the exclusion and inclusion criteria, 159 children diagnosed with PIDC were analysed at our hospital between January 2010 and November 2020. Patients' demographic and clinical data were collected, such as sex, pain, duration time, physical examination, white blood cell count, erythrocyte sedimentation rate, C-reactive protein, and radiography, computed tomography, and magnetic resonance imaging findings. Patients were followed up for at least 6 months, and radiography or symptoms were evaluated. Fisher's exact test or χ2-test was used for statistical analyses. RESULTS One hundred and fifty-nine patients were ultimately followed up with for about 12.5 ± 5.8 months. There were 103 male and 56 female, with an average age of 6.08 ± 2.62 years (2 months to 12 years). A total of 109 patients had only one PIDC, 29 patients had two PIDCs, and 21 patients had multiple PIDCs. Thirty patients were found incidentally and were asymptomatic. A total of 106 patients had neck torticollis. Sixteen patients had IDC herniations, fifteen patients had posterior longitudinal ligament calcification, two patients had anterior longitudinal ligament calcification, and 17 patients had herniation of the vertebral canal. All patients underwent conservative treatment, and none underwent surgery. All patients' symptoms resolved after either collar fixation or neck traction. CONCLUSION PIDC can be treated conservatively, even when accompanied by herniation, longitudinal ligament calcification, or clinical neck symptoms. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Kai Chen
- Department of Orthopedics, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Yuzhong District, Zhongshan 2road 136#, Chongqing, 400014, People's Republic of China
| | - Xin Chen
- Department of Radiology, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Yuxi Su
- Department of Orthopedics, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Yuzhong District, Zhongshan 2road 136#, Chongqing, 400014, People's Republic of China.
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Chang C, Zhu J, Li H, Yang Q. Enhanced magnetic resonance imaging manifestations of paediatric intervertebral disc calcification combined with ossification of the posterior longitudinal ligament: case report and literature review. BMC Pediatr 2022; 22:400. [PMID: 35804316 PMCID: PMC9264604 DOI: 10.1186/s12887-022-03461-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 06/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since the first description of paediatric intervertebral disc calcification (IDC) by Báron in 1924, only approximately 400 cases have been reported in the literature. Paediatric IDC combined with ossification of the posterior longitudinal ligament (OPLL) is an even rarer condition, with only 8 cases described in detail to date. In this paper, we present a review of the disease characteristics described in the relevant English language literature and discuss the possible mechanisms of lesion enhancement in contrast-enhanced magnetic resonance imaging (MRI). CASE PRESENTATION In May 2020, a 6-year-old Han nationality girl presented with the chief complaint of neck pain that had lasted for a week. She did not report a history of trauma or a past illness. On admission, there was no personal and family history, congenital diseases, or non-specific infections such as tuberculosis, among others. Further physical examination revealed that the movement of her cervical spine was limited. Computed tomography (CT) and MRI revealed ossification of the intervertebral discs and posterior longitudinal ligament (PLL) at the C4/5 levels and an absence of obvious spinal cord compression. When contrast-enhanced MRI was performed, significant enhancement was observed in the intervertebral discs and PLL at the C4/5 level. We adopted a non-interventional approach and performed an imaging re-examination 8 months later. Both the plain and contrast-enhanced MRI scans indicated swelling in the C4/5 intervertebral discs and disappearance of the previously observed enhancement in the nucleus pulposus (NP) and PLL at the corresponding levels; CT examination revealed that the ossified lesions had been completely resorbed. CONCLUSION Obvious lesion enhancement in contrast-enhanced MRI is an extremely rare manifestation of paediatric IDC combined with OPLL. However, the exact mechanisms of this phenomenon remain unclear. We surmise that it may be caused by a series of biophysical changes related to vertebral endplate injury and repair, but further research will be required for in-depth investigation.
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Affiliation(s)
- Cancan Chang
- Department of Medical Imaging, Bozhou Hospital of Traditional Chinese Medicine, Bozhou, 236800, Anhui, China.,Clinical Medicine Standardisation Training Trainees, Department of Medical Imaging, Anqing Hospital Affiliated to Anhui Medical University, Anqing, 246000, Anhui, China
| | - Juan Zhu
- Department of Medical Imaging, Anqing Hospital Affiliated to Anhui Medical University, Anqing, 246000, Anhui, China
| | - Hongyi Li
- Department of Radiology, The People's Hospital of Liaoning Province, Shenyang, 110016, China
| | - Qing Yang
- Department of Medical Imaging, Anqing Hospital Affiliated to Anhui Medical University, Renmin road, Anqing, 246000, Anhui, China.
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Zehra U, Tryfonidou M, Iatridis JC, Illien-Jünger S, Mwale F, Samartzis D. Mechanisms and clinical implications of intervertebral disc calcification. Nat Rev Rheumatol 2022; 18:352-362. [DOI: 10.1038/s41584-022-00783-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 12/19/2022]
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Wang XD, Su XJ, Chen YK, Wang WG. Regression of intervertebral disc calcification combined with ossification of the posterior longitudinal ligament: A case report. World J Clin Cases 2021; 9:7285-7291. [PMID: 34540990 PMCID: PMC8409183 DOI: 10.12998/wjcc.v9.i24.7285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/16/2021] [Accepted: 07/06/2021] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Xu-Dong Wang
- Department of Orthopaedic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Xian-Jun Su
- Department of Orthopaedic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Yao-Kun Chen
- Department of Orthopaedic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Wen-Gang Wang
- Department of Orthopaedic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
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King HJ, Ramchandani R, Maxwell C, Sarkar A, Loven T. To cut or not to cut? A case report on pediatric intervertebral disc calcification. Surg Neurol Int 2021; 12:307. [PMID: 34345448 PMCID: PMC8326060 DOI: 10.25259/sni_207_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/31/2021] [Indexed: 11/04/2022] Open
Abstract
Background: Intervertebral disc calcification (IVDC) is a rare cause of acute spinal pain in pediatric patients. The most common symptom is back or neck pain, but muscle spasm, muscle weakness, and sensory loss also occur. Many patients have an alarming presentation and radiological findings concerning for spinal cord compression. Case Description: A 10-year-old female presented with 2 weeks of worsening back pain and restricted neck flexion with no history of preceding trauma. Magnetic resonance imaging (MRI) showed T4/5 and T5/6 vertebral disc calcification and posterior herniation causing thoracic spinal cord compression. Despite concerning imaging findings, we decided to manage this patient conservatively with nonsteroidal anti-inflammatory drugs, leading to the improvement of symptoms within 9 days, and resolution of all pain within 1 month after hospital discharge. At 6 months follow-up, MRI showed complete resolution of calcification within the spinal canal. Conclusion: This case report emphasizes IVDC as an important differential diagnosis of pediatric disc disease that does not require surgical intervention. X-ray imaging with PA and lateral views is an adequate screening for these patients. Majority of cases resolve within 6 months with conservative therapy.
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Affiliation(s)
- Hunter J King
- Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States
| | - Rohin Ramchandani
- Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States
| | - Christina Maxwell
- Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States.,Department of Neurosurgery, Global Neurosciences Institute, Philadelphia, Pennsylvania, United States
| | - Atom Sarkar
- Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States.,Department of Neurosurgery, Global Neurosciences Institute, Philadelphia, Pennsylvania, United States.,Department of Neurosurgery, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, United States
| | - Tina Loven
- Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States.,Department of Neurosurgery, Global Neurosciences Institute, Philadelphia, Pennsylvania, United States.,Department of Neurosurgery, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, United States
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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).
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Zhu J, Sun K, Xu X, Sun J, Kong Q, Wang S, Shi J. A Preliminary Attempt of Nonintervention in the Treatment of Patients with Intervertebral Disc Calcification Combined with Ossification of the Posterior Longitudinal Ligament. World Neurosurg 2019; 129:181-185. [PMID: 31146042 DOI: 10.1016/j.wneu.2019.05.169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/18/2019] [Accepted: 05/20/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Calcification of intervertebral disc is a common impairment, which has been considered as the degenerative condition of the spine. In clinical practice, we note that the onset of intervertebral disc calcification (IDC) and ossification of the posterior longitudinal ligament (OPLL) can exist simultaneously in some cases, especially in younger children. However, only 8 cases have been reported in detail previously. In addition, controversy remains in terms of the best way to treat this condition. CASE DESCRIPTION An 8-year-old female child was referred to our department in March 2018 complaining of severe back pain and neck pain with a sign of neurologic dysfunction. Computed tomography and magnetic resonance imaging revealed the calcified intervertebral disc and OPLL at the C5-C6 level and spinal cord compression. We performed a noninterventional strategy for the patient. The patient's symptom recovered significantly in approximately 1 month. At 6 months of follow-up, the patient felt no discomfort, and computed tomography revealed the complete resorption of ossified lesion. Magnetic resonance imaging also showed no sign of compression on the spinal cord and nerve root at the involved segment. CONCLUSIONS Pediatric IDC accompanied with OPLL is much less frequent, but we must be aware of this disease. Since the distribution of this disease is age-specific and sex-specific, further research is necessary. Treatment for IDC combined with OPLL needs to follow the treatment principles as described in the text.
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Affiliation(s)
- Jian Zhu
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Kaiqiang Sun
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Ximing Xu
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Jingchuan Sun
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Qingjie Kong
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Shunmin Wang
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Jiangang Shi
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China.
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Pediatric Idiopathic Intervertebral Disc Calcification: Single-Center Series and Review of the Literature. J Pediatr 2019; 206:212-216. [PMID: 30466792 DOI: 10.1016/j.jpeds.2018.10.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 09/25/2018] [Accepted: 10/25/2018] [Indexed: 01/30/2023]
Abstract
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.
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Du JJ, Chen YF, Peng Y, Li XJ, Ma W. Calcification of the intervertebral disc and ossification of posterior longitudinal ligament in children. BMC Musculoskelet Disord 2018; 19:316. [PMID: 30185184 PMCID: PMC6124007 DOI: 10.1186/s12891-018-2227-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 08/09/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND IDC in children, first reported by Baron in 1924, is very rare. OPLL of the cervical spine mainly affect people ages 50-70 years. The coexistence of IDC and OPLL in children is very rare, only six cases with 3 to 24 months' follow-up were reported to date. CASE PRESENTATION A 6-year-old boy presented with complains of neck pain at July 2007. The boy was treated by conservative treatment and observed up for 9 years. Neck pain greatly improved after a one-month conservative treatment and never recur. Laboratory tests revealed elevated ESR and CRP at admission and found nothing abnormal at 19-month and 9-year follow-up. Computed tomography and magnetic resonance imaging revealed IDC at C2/3, C3/4 and OPLL at C3/4 at admission and found minor calcification at C2/3 remained but calcification at C3/4 and OPLL at C3/4 completely disappeared at 19-month and 9-year follow-up. Nineteen months after initial diagnosis, restoration of T2-weighted signal intensity of C2/3 and C3/4 discs was observed through MRI. Loss of T2-weighted signal intensity of C2/3 disc and decrease of T2-weighted signal intensity of C3/4 disc was observed at 9-year follow-up. CONCLUSIONS IDC with OPLL in children is very rare. Conservative treatments are recommended with affirmative short-term and long-term clinical effects. More intensive observation with long-term follow-ups may be needed to warrant the clinical effects.
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Affiliation(s)
- Jun-Jie Du
- Department of Orthopaedics, Air Force General Hospital of PLA, 30 Fucheng Road, Beijing, 100142, People's Republic of China.
| | - Yu-Fei Chen
- Department of Orthopaedics, Air Force General Hospital of PLA, 30 Fucheng Road, Beijing, 100142, People's Republic of China.
| | - Ye Peng
- Department of Orthopaedics, Air Force General Hospital of PLA, 30 Fucheng Road, Beijing, 100142, People's Republic of China
| | - Xiao-Jie Li
- Department of Orthopaedics, Air Force General Hospital of PLA, 30 Fucheng Road, Beijing, 100142, People's Republic of China
| | - Wei Ma
- Department of Orthopaedics, Air Force General Hospital of PLA, 30 Fucheng Road, Beijing, 100142, People's Republic of China
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