To cut or not to cut? A case report on pediatric intervertebral disc calcification

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.

Kawasaki disease with intervertebral disc calcification and torticollis

“…The mechanism by which KD and IVDC developed simultaneously is not clear, but overlapping etiologies, such as genetic susceptibility or previous infection, may have been involved. 1,5 In conclusion, this report helps to clarify the pathogenesis of KD with torticollis. We believe that detailed evaluation using imaging is necessary because IVDC may be involved in KD with torticollis.…”

“…Intervertebral disc calcification (IVDC) in childhood is rare. IVDC is characterized by calcification of the nucleus pulposus of a cervical disc, inflammation, and torticollis; it has a self‐limiting course 1–3 . Torticollis in Kawasaki disease (KD) patients is also a rare complication, and its pathogenesis has been reported to involve cervical lymphadenitis 4 .…”

“…The mechanism by which KD and IVDC developed simultaneously is not clear, but overlapping etiologies, such as genetic susceptibility or previous infection, may have been involved 1,5 …”

“…IVDC is characterized by calcification of the nucleus pulposus of a cervical disc, inflammation, and torticollis; it has a self-limiting course. [1][2][3] Torticollis in Kawasaki disease (KD) patients is also a rare complication, and its pathogenesis has been reported to involve cervical lymphadenitis. 4 We report a case of KD with inflammatory torticollis in which IVDC was considered to be involved in the pathogenesis.…”