Conservative Treatment for Cervical Radiculopathy Due to Extensive Foraminal Disc Calcification in Children

Abstract

Intervertebral disc calcification is a rare but well-recognized condition in children1-4. Intervertebral disc calcification mostly involves the cervical spine, and the most common symptom is neck pain, which usually disappears in a few days after symptomatic treatment, with subsequent disappearance of calcification on imaging studies within a few weeks to months5-7. Intervertebral disc calcification is a self-limiting condition with an excellent prognosis, and it rarely results in a neurologic deficit8-11. Therefore, surgical treatment is reserved for rare cases presenting with severe radicular pain, muscle weakness, or myelopathy due to nerve-root or spinal cord compression12-14. Surgery has been performed because of progressive neurologic deficits, including myelopathy, in several cases of intervertebral disc calcification12,15-18, with reports that the outcomes after surgical treatment were more favorable than those after conservative treatment13,19,20. Cervical radiculopathy may occur when disc calcification involves the nerve root. In 2004, Dai et al. reported on a series of seventeen children with cervical disc calcification, five of whom had neurologic symptoms involving the upper extremities, who were treated with conservative therapy1. However, the authors did not provide a description of foraminal stenosis due to intervertebral disc calcification or examine imaging findings in the intravertebral foramen. Furthermore, to our knowledge, detailed imaging findings in children after successful conservative treatment of cervical radicular pain with motor weakness caused by extensive disc calcification in the intervertebral foramen have not been reported in the English-language literature. Many orthopaedic surgeons are not convinced of the value of conservative therapy for intervertebral disc calcification in children who have severe radiculopathy with motor weakness. This concern arises from cases such as that of a nine-year-old boy with …