Intervertebral Disc Calcification

Intervertebral disc calcification is more common in adults than children. Overall, it is an uncommon condition. It was first described by Baron in 1924 and since that time more than 100 cases have been reported.

Intervertebral disc calcification is more common in boys than girls and usual age of presentation is 8-13 years.

It is most common in the cervical spine. When it occurs in cervical spine, it causes symptoms. Otherwise lesions have been detected in the thoracic spine in patients without any symptom.

Pathophysiology of Intervertebral Calcification

Usually, the calcification of the nucleus pulposus occurs and  the annular ligament is spared. The calcified nucleus pulposus may herniate anteriorly into the prevertebral soft tissues or posteriorly into the spinal canal.

Causes of Intervertebral Calcification

There is no clear cut causation of intervertebral disc calcification known. However, intervertebral disc calcification.

• Degenerative – May occur in up to 6% in routine abdominal radiographs in adults
• Postoperative
• Traumatic
• Ochronosis
• Ankylosing spondylitis
• Pseudogout
• Hemochromatosis
• Hypervitaminosis D
• Transient intervertebral disc calcification [children]
• Juvenile chronic arthritis
• Hyperparathyroidism
• Amyloidosis
• Poliomyelitis
• Acromegaly

Presentation

In adults, the condition is generally asymptomatic. In children, it is an acute condition.

The symptoms most commonly encountered are

• Neck pain
• Torticollis or tilting of the neck
• Reduced range of motion
• Approximately 25% of patients have fever

Anterior herniation may lead to difficulty in eating or dysphagia and posterior herniation can lead to neurological deficits or radicular pain.

Pain usually begins suddenly and persists for 2 to 3 weeks. 75% of children are asymptomatic by 3 weeks, and 95% are asymptomatic within 6 months. Disc herniation is rare, but posterior herniations can cause spinal cord compression, and anterior herniations may result in dysphagia.

Radicular pain or signs of nerve root compression are rare.

Imaging in Intervertebral Disc Calcification

Radiographs show images of calcium density in the normally radiolucent intervertebral discs. Anterior or posterior protrusion can be observed.

CT and MRI are generally not required but may be able to differentiate the lesion better.

Treatment of Intervertebral Disc Calcification

In children, the lesion shows complete clinical and radiographic resolution all cases. More than 50% patients are symptom free within 3 weeks and 95% within 6 months.

Surgery is  required only in rare cases where conservative management fails in a child with severe radiculopathy or sensorimotor deficits.

Appropriate treatment consists of rest, cervical immobilization, and analgesics.

The radiographs show regression or disappearance of the calcified deposits in 90%.

The long-term effects of intervertebral disc calcification are not known.

References

1. . Bagatur AE, Zorer G, Centel T. Natural history of paediatric intervertebral disc calcification. Arch Orthop Trauma Surg. 2001;121:601–3
2. Sonnabend DH, Taylor TK, Chapman GK. Intervertebral disc calcification syndromes in children. J Bone Joint Surg B. 1982;64:25–31.
3. Interverteral Disc Calcification, Radiopaedia, URL – http://radiopaedia.org/articles/intervertebral-disc-calcification. Accessed on 3 April 2016. [Link]