Pediatric idiopathic intervertebral disc calcification is a rare condition affecting intervertebral discs, adjacent vertebral bodies, and musculo-ligamentous structures, typically resulting in local pain or sensorimotor disturbances. First described by Baron in 1924 1, the underlying etiology is poorly understood, with some theories suggesting inflammatory or post-traumatic origins, as well as viral-induced vasculitis. It is usually a self-limiting manifestation, and clinical symptoms resolve spontaneously within weeks or months.
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Epidemiology
There is a male predominance, with the condition most commonly occurring between the ages of 5 and 12. The lower cervical spine is the area most frequently affected 2.
Clinical Presentation
Neck pain is the most frequently observed manifestation, although imaging findings have been identified in individuals without symptoms. Additional accompanying symptoms may include paraspinal muscle spasms, torticollis, and fever. Laboratory assessments may reveal an elevated white blood cell count and erythrocyte sedimentation rate 3. The incidence of disc herniation is more than 30% in symptomatic patients; however, neurological deficits are rarely reported. Typically, the disease follows a course leading to complete clinical and radiographic resolution. Over 50% of patients experience symptom relief within three weeks, and 95% achieve resolution within six months. Surgical intervention is only necessary in rare cases, specifically when conservative management proves ineffective in a child exhibiting severe radiculopathy or sensorimotor deficits. Radiological resorption of pediatric intervertebral calcification is commonly observed within three months 4.
Radiographic features
Plain Radiograph / CT
Round, flat, oval, or spotty calcifications of the nucleus pulposus can be observed in the affected disk space, with or without associated disc herniation. The calcified material may herniate anteriorly into the prevertebral soft tissue or posteriorly into the spinal canal or to the adjacent bone plates.
MRI
Hypointense intervertebral discs are visible on both T1 and T2 weighted sequences, consistent with calcification. Additionally, features may include intervertebral disc herniation with or without foraminal stenosis, peridiscal inflammatory changes, and marrow edema with or without narrowed spinal canal caliber.
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