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Calcified Lumbar Disc Herniation in Children

Mohammed Benzagmout *, Saïd Boujraf **, ***, Taoufik Harzy#, Khalid Chakour *, Mohammed El Faïz Chaoui *

* Department of Neurosurgery, University Hospital Hassan II, Fez- Morocco .
**Department of Biophysics and Clinical MRI Methods Department, Faculty of Medicine and Pharmacy, University of Fez
Department of Radiology, University Hospital Hassan II, Fez- Morocco .
Department of Rheumatology, University Hospital Hassan II, Fez- Morocco

Address for Correspondence:

Associate Prof. Saïd Boujraf
Department of Biophysics and Clinical MRI Methods Department
Faculty of Medicine and Pharmacy, University of Fez
BP. 1893; Km 2.200, Sidi Hrazem Road ; Fez 30000; Morocco
Phone: 00 212 67 780 442, Fax: 00 212 35 619 321


Discal calcification in childhood is rare. We report a 12-year-old boy who presented an acute low-back pain, right L5 hyperalgic sciatica with a history of increasing paresthesia. CT scan demonstrated a postero-lateral calcified disc herniation at the L4-L5 level. The patient was operated and successfully recovered. Clinical presentation, neuroimaging findings and treatment modalities of this phenomenon are discussed.

J.Orthopaedics 2007;4(3)e24

lumbar disc herniation, intervertebral disc calcification, infant, surgery


The surgery of lumbar disc herniation is a relatively uncommon in children. In published series, children generally constitute 0.5 to 3% of all patients surgically treated for lumbar disc herniation [3, 4]. Moreover, calcifications of the intervertebral disc occur rarely at childhood stage [13], and most commonly involve the lower cervical spine [6]. It may be an incidental finding, or associated to distinct clinical syndrome, and it is rarely associated to neurological deficit [15].

In this paper, we present the case of a calcified lumbar disc herniation revealed in a child of 12 years by hyperalgesic sciatica. The patient was operated in emergency with a very good outcome.

Case Report :

Our patient was a 12 years old sportive boy, admitted at the neurosurgical emergency department for a severe pain of the lumbar spine. He reported low back pain, difficulty of walk, typical right L5 sciatica and a history of increasing paresthesia in his lower limbs. There was no history of trauma. These symptoms occurred one month earlier and the patient has received treatment consisting in analgesics, non- steroidal anti-inflammatory drugs and muscle relaxant for a period of three weeks without any improvement of his complaints. Moreover, the patient reported an increasing severity of symptoms justifying radiological exploration. At admission, the physical examination revealed radiative spinal syndrome (muscular tightness associated to antalgic attitude by trunk flexion, Lasegue sign of 30° toward the right). However, the neurological examination did not reveal any motor or sensory deficits.

The basic x-rays of the lumbar spine did not show any particular signs. Whereas CT scan of the lumbosacral junction demonstrated a postero-lateral calcified disc herniation localized at the L4-L5 level (Figure 1). 

Figure 1: CT scan of the lumbar spine in axial views at the level of L4-L5 intervertebral disc (a) and the superior vertebral plateau of L5 demonstrating a postero-lateral calcified disc herniation.

The others lumbar intervertebral spaces were normal. We recommended that the patient undergo L4-L5 discectomy. In surgery, we discovered a calcified lumbar disc herniation at the level of L4-L5 without clear conflict with the L5 nerve root. A bilateral foraminotomy was performed and the patient showed spectacular improvement of his symptoms after surgery. After two months, the patient returned progressively to practice his favorite preoperative sport and lifestyle.

Discussion :

Calcified intervertebral discs is very rare in children, it was firstly described by Baron in 1924 [2], about 250 cases were previously reported the literature [8]. In fact, the real incidence of this pathology in children and adolescents is still controversial according to the upper age limit of this population.

The etiology of disc calcification in children remains unclear [7, 15]; however, it is possibly different from the degenerative calcification seen in adults. Trauma has often been implicated as a predisposing factor since the calcification of disc in some children was preceded by trauma [6, 12, 15, 17]. However, preexisting disc calcification was also identified in some children [14], and most patients have no history of injury. Furthermore, disc calcification in newborns has been reported [10]. Thus, it is difficult to determine the relationship between trauma and disc calcification in children.

Indeed, several factors have been investigated, such as familial predisposition, the presence of morphologic and functional alterations, congenital malformations, growth disturbances, and vertebral slipping epiphysis. Nevertheless, traumatism is often mentioned as the primary causative factor [5].

The mean age at onset is about 7 to 8 years with a slight male preponderance. The clinical presentation is variable. Most patients have local symptoms including pain, muscular tension and functional limitation [8]; some patients may have a fever [9]. Rechtman et al. [14] classified the clinical symptoms of disc calcification as “disappearing”, “dormant” and “silent” types. The severity of the symptoms is often not correlated with the radiographic findings [12], and the calcification may be only an incidental finding [14, 16]. In most cases, it has been accepted that disc calcification in children is self-limiting and has an excellent prognosis [8]. However, herniation of calcified discs occasionally leads to acute nerve-root or spinal cord compression urging a surgical decompression [9]. This was the case of our patient who experienced sudden hyperalgesic sciatica without any history of symptoms.

Radiographically, the calcified discs are usually seen as a dense round or oval mass within the nucleus pulposus. Both CT and MRI can demonstrate an associated disc herniation [12]. The calcification has been described as having low signal intensity on magnetic resonance images [12], although hyper-intense discs on the T1-weighted image are associated with calcification [1]. Disc calcifications are mostly found in the cervical spine with a clear predilection for the C6-C7 level [8]. The thoracic area is rarely involved [10] whereas the lumbar spine is exceptionally affected [16]. Multiple disc involvement has also been reported [8].

Conservative treatment is usually effective [17]. It allows the disappearance of clinical symptoms in 70% of cases in parallel to calcified disc vanishing. In fact, most of authors believe that surgical intervention for the treatment of nerve-root or spinal cord compression by a calcified disc is rarely indicated. However, surgical intervention has been reported in some patients with intractable pain and/or a progressive neurological deficit [9, 15]. In our case, the intervention was justified by the severity of the radiculopathy that was rebel for medical treatment.

The prognosis of intervertebral disc calcification in children is excellent [8]; and complications rarely occur [11].


Disc calcification in childhood represents a rare entity. It is mostly revealed by a characteristic acute spinal pain and usually follows a benign course. CT scan is the exam of choice. It allows to confirm the diagnosis and to exclude other diseases, mainly bacterial spondylo-discitis. Surgery is rarely required and the prognosis is usually excellent.

Reference :

  1. Bangert AB, Modic MT, Ross JS, Obuchowski NA, Perl J, Ruggieri PM, Masaryk TJ. Hyperintense disks on T1-weighted MR images: correlation with calcification. Radiology. 1995; 195: 437-43.

  2. Baron, A.: Uber eine neue Erkrankung der Wirbelsaüle. Jahrb. Kinderh. 1924; 104: 357-360.

  3. Beks JW, Weeme CAT. Herniated lumbar discs in teenagers. Acta Neurochirurgica (Wien) 1975; 31: 195-199.

  4. DeOrio JK, Bianco A. Lumbar disc excision in children and adolescents. J Bone J Surg 1982; 64A: 991-5.

  5. Epstein JA, Epstein NE , Marc J, et al. Lumbar intervertebral disc herniation in teenage children: recognition and management of associated anomalies. Spine 1984; 9: 427-32.

  6. Eyring EJ, Peterson CA , Bjornson DR. Intervertebral-disc calcification in childhood: a distinct clinical syndrome. J Bone Joint Surg Am. 1964; 46: 1432-41.

  7. Gerlach R, Zimmermann M, Kellermann S, Lietz R, Raabe A, Seifert V. Intervertebral disc calcification in childhood: A case report and review of the literature. Acta Neurochir (Wien) 2001; 143: 89-93.

  8. Harvet G., De Pontual L., B. Neven, et al.Calcifications discales de l’enfant : à propos de deux observations et revue de la littérature. Archives de pédiatrie 2004 ; 11 : 1457-1461.

  9. Li-Yang D, Hua Y, Qi-Rong Q. The Natural History of Cervical Disc Calcification in Children. J. Bone Joint Surg. Am. 2004; 86: 1467-1472.

  10. MacCartee CC Jr, Griffin PP, Byrd EB. Ruptured calcified thoracic disc in a child. Report of a case. J Bone Joint Surg Am. 1972; 54: 1272-4.

  11. Mahlfeld K, Kayser R, Grasshoff H. Permanent thoracic myelopathy resulting from herniation of a calcified intervertebral disc in a child. J Pediatr Orthop B 2002; 11: 6-9.

  12. McGregor JC, Butler P. Disc calcification in childhood: computed tomographic and magnetic resonance imaging appearances. Br J Radiol. 1986; 59: 180-2.

  13. Prescher A. Anatomy and pathology of the aging spine. Eur J Radiol. 1998; 27: 181-95.

  14. Rechtman AM, Hermel MB, Albert SM, Boreadis AG. Calcification of the intervertebral disk: disappearing, dormant and silent. Clin Orthop. 1956; 7: 218-31.

  15. Smith RA, Vohman MD, Dimon JH 3rd, Averett JE Jr, Milsap JH Jr. Calcified cervical  intervertebral discs in children: report of three cases. J Neurosurg. 1977; 46: 233-8.

  16. Ventura N, Huguet R, Salvador A, Terricabras L, Cabrera AM. Intervertebral disc calcification in childhood. Int Orthop. 1995; 19: 291-4.

  17. Wong CC, Pereira B, Pho RW. Cervical disc calcification in children. A longterm review. Spine. 1992; 17: 139-44.  

This is a peer reviewed paper 

Please cite as : Mohammed Benzagmout: Calcified Lumbar Disc Herniation in Children

J.Orthopaedics 2007;4(3)e24





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