Multilevel paediatric idiopathic intervertebral disc calcifi
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Paediatric idiopathic intervertebral disc calcification (PIIDC) is characterised by radiographic evidence of single or multiple level oval-shaped calcifications mainly affecting the nucleus pulposus of the intervertebral disc. The most common region is the lower cervical spine followed by the thoracic spine and very rarely the lumbar spine.

The present case has been reported in the South African Orthopaedic Journal. A12-year-old male presented to our emergency department with a five-day history of spontaneous onset neck stiffness and low grade fever. No recent trauma was reported, and his past medical history was unremarkable. On physical examination he did not show signs of photophobia, vomiting nor any focal neurological deficit. The patient had full range of motion of the neck; pain was only exacerbated with forward flexion.

Mild central vertebral tenderness at the thoracolumbar junction was present with some vague abdominal discomfort. Laboratory findings revealed a raised C-reactive protein of 47 mg/L and ESR level of 64 mm/hr. Other results included a normal white cell count, serum calcium and alkaline phosphatase.

A lumbar puncture was done and cerebral spinal fluid microscopy and chemistry was within normal limits. Our surgery department was consulted and investigations revealed no intra-abdominal pathology contributing to the pain. Spinal radiographs revealed multiple level intervertebral disc calcifications. Computer tomography showed lesions with increased density consistent with calcifications at the T1–T4, T10–T12, L1–L2 and S5–coccyx levels.

The patient was admitted for bed rest, analgesia and non-steroidal anti-inflammatories. He responded within five days of admission with complete resolution of neck stiffness and pain. At his six-week follow-up, he had no signs of recurrence and complete symptomatic recovery, with radiographic imaging revealing minimal resolution of the calcifications. At the three-month follow-up visit there were no signs of further radiographic resorption of the calcifications. Clinically the patient remained asymptomatic.

Lessons learnt:-
• Multilevel paediatric idiopathic intervertebral disc calcification is a rare entity that requires radiological and biochemical investigations to exclude other more sinister spinal conditions.

• The identification of PIIDC and the understanding of its natural course is crucial. Management is largely symptomatic and multidisciplinary with predictable resolution of symptoms and resorption of the lesions over time.

• Only in exceptional cases is surgery considered

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