Case of the Month
Section Editor: Nicholas Stence, MD
Children's Hospital Colorado, Aurora, CO
July 2023
Next Case of the Month Coming August 8...
Adult-Onset Acute Calcific Discitis
- Background:
- Acute calcific discitis is a rare condition of unknown etiology observed usually in childhood. However, there have been a few cases described in the adult population.
- The most common hypothesis is the presence of a vascular insult, which could eventually lead to discal calcification by interrupting blood supply to the nucleus pulposus.
- In adults, this condition is more often located at the middle or lower thoracic spine, while cervical localization is more frequently encountered in children.
- The diagnosis of acute calcific discitis must be recognized early to avoid discovertebral biopsy or antibiotics use.
- Clinical Presentation:
- Sudden onset of severe spine pain with or without fever and/or elevated inflammatory parameters
- Remission of symptoms following resolution of herniated calcified nucleus pulposus is common within a few days or weeks.
- Key Diagnostic Features:
- Bone edema:
- MRI: low signal intensity on T1, high signal on T2/STIR images, and intense enhancement after gadolinium administration
- Calcification:
- CT: intradiscal calcium density content, usually migrated to adjacent vertebral body through a bony defect of the inferior endplate
- MRI: intradiscal and inferior endplate lesion of very low signal in all sequences representing calcification
- Bone edema:
- Differential Diagnoses:
- Infection
- Neoplastic involvement of vertebral body
- Other inflammatory diseases
- Treatment:
- Patients usually experience complete resolution of symptoms after a few days or weeks with conservative treatment with anti-inflammatory drugs and rest.
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