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Journal of Pediatric Orthopaedics:
doi: 10.1097/BPO.0000000000000105

A Pediatric Case of Single-level Idiopathic Cervical Intervertebral Disk Calcification With Symptom Relapse 1 Year After Initial Onset

Sasagawa, Takeshi MD*; Hashimoto, Fumio MD*; Nakamura, Takuya MD*; Maruhasi, Yoshinobu MD*; Matsumoto, Naoyuki MD*; Segawa, Takeshi MD*; Yamamoto, Daiki MD*; Goshima, Kenichi MD; Murakami, Hideki MD; Tsuchiya, Hiroyuki MD

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Background: To date there has been only 1 reported case of the symptom relapse of pediatric idiopathic intervertebral disk calcification (PIIDC), as described by Yoon and colleagues in 1987, who reported symptom relapse in a patient with multilevel PIIDC. Thus, symptom relapse in patients with single-level PIIDC have not been reported.

Methods: We report here a case of single-level PIIDC with symptom relapse 1 year after the initial onset.

Results: The patient was a 7-year-old girl who developed cervical pain and fever up to 38°C without an obvious cause. Computed tomography (CT) revealed calcification in the C4/5 intervertebral disk space and in the epidural space at the C3-5 vertebral levels. The patient was diagnosed with PIIDC and treatment with oral nonsteroidal anti-inflammatory drugs was begun. Both cervical pain and fever gradually improved and resolved in approximately 1 week. CT obtained 6 months after the initial onset showed calcifications localized in the posterior area of the C4/5 intervertebral disk space and reduced epidural calcifications, which had nearly resolved. One year after the initial onset, the patient developed similar symptoms. CT revealed an enlarged calcified lesion in the epidural space. Thus, the patient was diagnosed with symptom relapse of PIIDC. Although there was enlargement of calcifications in the epidural space, there were no calcifications involving the intervertebral disk at the time of relapse. The patient was treated conservatively. Follow-up CT revealed that the lesion resolved with time.

Conclusions: This report described a patient with single-level PIIDC and symptom relapse 1 year after the initial onset. In the case presented herein, calcifications of the intervertebral space had extruded into the epidural space, thus causing a symptom relapse. The patient was treated conservatively at the initial onset and at the time of relapse. The symptoms improved both times. Although patients with single-level PIIDC usually have an uneventful clinical course, it is necessary to be mindful of potential symptom relapse.

© 2014 by Lippincott Williams & Wilkins

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