261ms
Updated: 2/8/2022

Pediatric Intervertebral Disc Calcification

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  • Summary
    • Pediatric Intervertebral Disc Calcification is a very rare condition of unknown etiology. 
    • Textbook presentation is child with neck pain, fever, malaise, and an elevated ESR and presumably CRP.  
    • Treatment is typically conservative, and the disease is usually self-limiting with a favorable prognosis
  • Epidemiology
    • Incidence
      • <0.01% 
    • Demographics
      • 2:1 male to female ratio
      • 6-10 years 
    • Location
      • classically cervical spine
        • typical location lower cervical spine, specifically C6-C7, however can occur anywhere in the spine 
      • thoracic, lumbar, and multiple level involvement have been rarely 
    • Risk factors
      • unknown
  • Etiology
    • Pathophysiology
      • unknown
      • possible pathophysiology causes:
        • trauma
        • inflammatory or infectious etiopathogenetic
        • aseptic necrosis
        • disorders of vitamin D metabolism
        • abnormal blood supply 
    • Genetics
      • now known genetic pattern
  • Anatomy
    • Intervertebral disc
      • annulus
      • nucleus pulposus
  • Classification
    • Single vs. Multiple Disc Levels
    • Symptomatic vs. Asymptomatic
  • Presentation
    • Symptoms
      • neck pain (67-80%)
        • may present as acute, subacute, and chronic pain
      • torticollis (20-22%)
      • stiffness
      • low grade fever (10%)
      • weakness (rare)
    • Physical exam
      • inspection
        • torticollis
      • motion
        • limited range of motion (14-33%)
      • neurovascular
        • neurological deficit (11-38% according to some series, but in reality this is rare)
  • Imaging
    • Radiographs
      • recommended views
        • AP and lateral
      • findings
        • calcificaiton of the disc
          • may appear as dense round or oval mass in the nucleus pulposus, or may be difusse calcification of the disc at one or more discs
    • CT
      • indications
        • may be used to rule out congenital fusion
    • MRI
      • indications
        • neurologic deficits
        • concern for disc herniation
      • findings
        • diminished signal intensity on MRI
  • Studies
    • Labs
      • ESR
      • CRP
  • Differential
    • Congenital Fusion/Klippel-Feil Syndrome (KFS)
      • classic triad
        • short webbed neck
        • low posterior hairline
        • limited cervical range of motion
    • Atlantoaxial rotatory subluxation
      • post-traumatic or post infectious (Grisel’s disease)
  • Treatment
    • Nonoperative
      • observation
        • indications
          • standard of care unless for vast majority of case
        • modalities
          • analgesic and anti-inflammatory medications
          • neck collar 
        • outcomes
          • symptomatic improvement after several
          • 95% of patients have resolution within 6 months of presentation
          • radiographic resolution lags behind clinical resolution my many months at least
    • Operative
      • neurologic decompression
        • indications
          • neurologic deficits with mass effect on spinal cord
          • intractable pain
  • Complications
    • Neurologic deficits (either nerve root or spinal cord)
      • incidence
        • extremely rare
          • may be associated with lesions in the annulus fibrosus 
  • Prognosis
    • Natural history
      • generally accepted as self-limiting and has an excellent prognosis

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