Pediatric intervertebral disc calcification: A no touch lesion
A 7-year-old boy presented to the emergency department with complaints of severe neck pain and restricted movements of sudden onset. There was no history of fever or significant trauma. The general physical and neurological examination was within normal limits except for mild tenderness in upper cervical area. There was no associated sensorimotor deficit or radiculopathy.\nThe routine laboratory examination including total leukocyte count (TLC), erythrocyte sedimentation rate (ESR), as well as serum calcium, Vitamin D3, alkaline phosphatase, and parathyroid hormone (PTH) levels were within normal limits.\nRadiograph of the cervical spine in anteroposterior and lateral projections showed calcification of the intervertebral disc at C2-3 level []. Computed tomography (CT) of the spine confirmed the presence of IVDC and also showed calcification in the adjoining anterior epidural space. There was no associated erosion of adjoining vertebral end plates and no pre- or paravertebral soft tissue component []. Magnetic Resonance Imaging (MRI) of the cervical spine demonstrated altered signal intensity involving intervertebral disc at C2–3 level with areas of T1 and T2 hypointensity, consistent with calcification. There was associated significant posterior protrusion of the calcified disc material into the anterior epidural space with compression of underlying cervical spinal cord; however, no signal changes were seen within the cord [].\nBased on the clinical presentation, normal laboratory examination, and radiological appearance, a diagnosis of childhood IVDC was made. The child was put on conservative management including analgesics and cervical collar.\nThere was significant improvement in symptoms after 1 week and complete resolution on 8 weeks follow-up. Follow-up MRI done after 3 months [] demonstrated near-complete resolution of the disc calcification and posterior protrusion.