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CC BY-NC-ND 4.0 · Asian J Neurosurg 2019; 14(03): 1021-1029
DOI: 10.4103/ajns.AJNS_119_19
Case Report

Acute calcific discitis or symptomatic calcified schmorl's node of the upper thoracic spine in an adult: A case report and literature review

Prasert Iampreechakul
Department of Neurosurgery, Prasat Neurological Institute, Bangkok
,
Punjama Lertbutsayanukul
1   Department of Neuroradiology, Prasat Neurological Institute, Bangkok
,
Narupat Suanprasert
2   Department of Neurology, Prasat Neurological Institute, Bangkok
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We describe a patient with acute calcific discitis following symptomatic Schmorl's node (SN) of upper thoracic spine. A 28-year-old female suffered from sudden severe pain in mid-thoracic, left scapular area, radiating to her chest. Plain radiography of the thoracic spine showed calcification in T3–4 intervertebral disc space. Computed tomography (CT) scan and magnetic resonance imaging (MRI) of the spine demonstrated calcification of the T3–T4 nucleus pulposus, migrating into the inferior of T3 vertebral body with reactive bone marrow edema. By conservative treatment with multidrug therapy, the pain subsided and disappeared in 3 months. Follow-up CT scan and MRI of the thoracic spine confirmed complete resolution of calcified SN and reactive bone marrow edema.

Key-words:

Acute calcific discitis - adult - spontaneous regression - symptomatic Schmorl's node - upper thoracic spine

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Nil.




Publication History

Article published online:
09 September 2022

© 2019. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Grivé E, Rovira A, Capellades J, Rivas A, Pedraza S. Radiologic findings in two cases of acute Schmörl's nodes. AJNR Am J Neuroradiol 1999;20:1717-21.
  • 2 Nogueira-Barbosa MH, Crema MD, da Silva Herrero CF, Pasqualini W, Defino HL. The several faces of Schmorl's node: Pictorial essay. Coluna/Columna 2015;14:320-3.
  • 3 Smith DM. Acute back pain associated with a calcified Schmorl's node: A case report. Clin Orthop Relat Res 1976;117:193-6.
  • 4 Xu N, Wei F, Liu X, Jiang L, Liu Z. Calcific discitis with giant thoracic disc herniations in adults. Eur Spine J 2016;25 Suppl 1:204-8.
  • 5 Sari H, Misirlioglu TO, Palamar D. Regression of a symptomatic thoracic disc herniation with a calcified intervertebral disc component. Acta Orthop Traumatol Turc 2016;50:698-701.
  • 6 Nogueira-Barbosa MH, da Silva Herrero CF, Pasqualini W, Defino HL. Calcific discitis in an adult patient with intravertebral migration and spontaneous remission. Skeletal Radiol 2013;42:1161-4.
  • 7 Shah A, Botchu R, Grainger MF, Davies AM, James SL. Acute symptomatic calcific discitis in adults: A case report and review of literature. Skeletal Radiol 2015;44:1819-24.
  • 8 Hu SB, Niu LS, Zheng WB, Sun T, Sun MY. Paralysis resulting from calcific discitis with acute herniation. Chin Med J (Engl) 2017;130:2643-4.
  • 9 Bazzi J, Dimar JR, Glassman SD. Acute calcific discitis in adults. Am J Orthop (Belle Mead NJ) 2002;31:141-5.
  • 10 Logue V. Thoracic intervertebral disc prolapse with spinal cord compression. J Neurol Neurosurg Psychiatry 1952;15:227-41.
  • 11 Ryan RW, Lally JF, Kozic Z. Asymptomatic calcified herniated thoracic disks: CT recognition. AJNR Am J Neuroradiol 1988;9:363-6.
  • 12 Williams R. Complete protrusion of a calcified nucleus pulposus in the thoracic spine; report of a case. J Bone Joint Surg Br 1954;36-B:597-600.
  • 13 Taylor TK, Little K. Prolapsed calcified thoracic intervertebral disc. J Pathol Bacteriol 1964;88:153-7.
  • 14 Lipson SJ, O'Connell JX. Case records of the Massachusetts general hospital weekly clinicopathological exercises case 37-1991: A 47-year-old woman with back pain and a lesion in a vertebral body. N Engl J Med 1991;325:794-9.
  • 15 Seymour R, Williams LA, Rees JI, Lyons K, Lloyd DC. Magnetic resonance imaging of acute intraosseous disc herniation. Clin Radiol 1998;53:363-8.
  • 16 Jevtič V. A calcified cervical intervertebral disc in a child and a thoracic disc calcification in an adult with posterior herniation-radiographic, computed tomography and magnetic resonance imaging findings. Radiol Oncol 2004;38:339-47.
  • 17 Rodacki MA, Castro CE, Castro DS. Diffuse vertebral body edema due to calcified intraspongious disk herniation. Neuroradiology 2005;47:316-21.
  • 18 Piccirilli M, Lapadula G, Caporlingua F, Martini S, Santoro A. Spontaneous regression of a thoracic calcified disc herniation in a young female: A case report and literature review. Clin Neurol Neurosurg 2012;114:779-81.
  • 19 Eap C, Bennis S, Blauwblomme T, Compaore P, Chamsedine A, Mireau E, et al. Spontaneous resorption of thoracic calcified disc herniation: Report of two cases and review of the literature. Neurochirurgie 2012;58:353-7.
  • 20 Azizaddini S, Arefanian S, Redjal N, Walcott BP, Mollahoseini R. Adult acute calcific discitis confined to the nucleus pulposus in the cervical spine: Case report. J Neurosurg Spine 2013;19:170-3.
  • 21 Ahmad FU, Schallert E, Bregy A, Post JD, Vanni S. Disappearing large calcified thoracic disc herniation in a patient with thalassaemia. BMJ Case Rep 2016;2016. pii: bcr2015213166.
  • 22 Yue B, Chen B, Zou YW, Xi YM, Ren XF, Xiang HF, et al. Thoracic intervertebral disc calcification and herniation in adults: A report of two cases. Eur Spine J 2016;25 Suppl 1:118-23.
  • 23 Umit E, Fatih Y, Hasan CU. Lumbar intervertebral disc calcification: A case report. Nov Approaches Drug Des Dev 2017;1:1-3.
  • 24 Sadek AR, Dare C, McGillion S, Nader-Sepahi A, Skiadas V. Lumbar intravertebral disc herniation secondary to idiopathic calcific discitis. Br J Neurosurg 2017;31:1-5.
  • 25 Harshavardhana NS, Panvica TP, Pinto MR. Spontaneous regression of a large symptomatic calcified central thoracic disc herniation: A case report with a review of the literature. J Head Neck Spine Surg 2017;1:1-4.
  • 26 Oligane H, Rongo J, Agarwal V, Branstetter BF 4th. Spontaneous regression of a large calcified thoracic disk extrusion. Skeletal Radiol 2018;47:1177-82.
  • 27 Kato T, Haro H, Komori H, Shinomiya K. Sequential dynamics of inflammatory cytokine, angiogenesis inducing factor and matrix degrading enzymes during spontaneous resorption of the herniated disc. J Orthop Res 2004;22:895-900.
  • 28 Peck FC Jr. A calcified thoracic intervertebral disk with herniation and spinal cord compression in a child; case report. J Neurosurg 1957;14:105-9.
  • 29 Yasuma T, Arai K, Yamauchi Y. The histology of lumbar intervertebral disc herniation. The significance of small blood vessels in the extruded tissue. Spine (Phila Pa 1976) 1993;18:1761-5.
  • 30 Al-Mahfoudh R, Mitchell PS, Wilby M, Crooks D, Barrett C, Pillay R, et al. Management of giant calcified thoracic disks and description of the trench vertebrectomy technique. Global Spine J 2016;6:584-91.
  • 31 Merolla G, Singh S, Paladini P, Porcellini G. Calcific tendinitis of the rotator cuff: State of the art in diagnosis and treatment. J Orthop Traumatol 2016;17:7-14.
  • 32 Wainner RS, Hasz M. Management of acute calcific tendinitis of the shoulder. J Orthop Sports Phys Ther 1998;27:231-7.