Sasagawa Takeshi, Hashimoto Fumio, Nakamura Takuya, Maruhasi Yoshinobu, Matsumoto Naoyuki, Segawa Takeshi, Yamamoto Daiki, Goshima Kenichi, Murakami Hideki, Tsuchiya Hiroyuki
*Department of Orthopedics Surgery, Toyama Prefectural Central Hospital †Department of Orthopedics Surgery, Toyama City Hospital, Toyama City ‡Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Japan.
J Pediatr Orthop. 2014 Apr-May;34(3):282-6. doi: 10.1097/BPO.0000000000000105.
To date there has been only 1 reported case of the symptom relapse of pediatric idiopathic intervertebral disk calcification (PIIDC), as described by Yoon and colleagues in 1987, who reported symptom relapse in a patient with multilevel PIIDC. Thus, symptom relapse in patients with single-level PIIDC have not been reported.
We report here a case of single-level PIIDC with symptom relapse 1 year after the initial onset.
The patient was a 7-year-old girl who developed cervical pain and fever up to 38°C without an obvious cause. Computed tomography (CT) revealed calcification in the C4/5 intervertebral disk space and in the epidural space at the C3-5 vertebral levels. The patient was diagnosed with PIIDC and treatment with oral nonsteroidal anti-inflammatory drugs was begun. Both cervical pain and fever gradually improved and resolved in approximately 1 week. CT obtained 6 months after the initial onset showed calcifications localized in the posterior area of the C4/5 intervertebral disk space and reduced epidural calcifications, which had nearly resolved. One year after the initial onset, the patient developed similar symptoms. CT revealed an enlarged calcified lesion in the epidural space. Thus, the patient was diagnosed with symptom relapse of PIIDC. Although there was enlargement of calcifications in the epidural space, there were no calcifications involving the intervertebral disk at the time of relapse. The patient was treated conservatively. Follow-up CT revealed that the lesion resolved with time.
This report described a patient with single-level PIIDC and symptom relapse 1 year after the initial onset. In the case presented herein, calcifications of the intervertebral space had extruded into the epidural space, thus causing a symptom relapse. The patient was treated conservatively at the initial onset and at the time of relapse. The symptoms improved both times. Although patients with single-level PIIDC usually have an uneventful clinical course, it is necessary to be mindful of potential symptom relapse.
迄今为止，仅有1例小儿特发性椎间盘钙化（PIIDC）症状复发的报道，是Yoon及其同事于1987年报道的1例多节段PIIDC患者出现症状复发。然而，单节段PIIDC患者症状复发的情况尚未见报道。
我们在此报告1例单节段PIIDC患者，初始发病1年后出现症状复发。
该患者为一名7岁女孩，无明显诱因出现颈部疼痛及体温高达38°C的发热症状。计算机断层扫描（CT）显示C4/5椎间盘间隙及C3 - 5椎体水平硬膜外间隙有钙化。该患者被诊断为PIIDC，并开始口服非甾体类抗炎药治疗。颈部疼痛和发热症状均逐渐改善，并在约1周内缓解。初始发病6个月后进行的CT检查显示，钙化局限于C4/5椎间盘间隙后部区域，硬膜外钙化减少，几乎已消失。初始发病1年后，患者再次出现类似症状。CT显示硬膜外间隙有增大的钙化病灶。因此，该患者被诊断为PIIDC症状复发。尽管复发时硬膜外钙化有增大，但椎间盘当时并无钙化累及。该患者接受了保守治疗。随访CT显示病灶随时间逐渐消退。
本报告描述了1例单节段PIIDC患者，初始发病1年后出现症状复发。在本病例中，椎间隙钙化已突入硬膜外间隙，从而导致症状复发。该患者在初始发病时及复发时均接受了保守治疗。两次症状均得到改善。尽管单节段PIIDC患者通常临床过程平稳，但仍需留意潜在的症状复发情况。
