Xu Nanfang, Wei Feng, Liu Xiaoguang, Jiang Liang, Liu Zhongjun
Department of Orthopaedics, Peking University Third Hospital, 49 Huayuan North Road, Beijing, 100191, China.
Eur Spine J. 2016 May;25 Suppl 1:204-8. doi: 10.1007/s00586-016-4402-y. Epub 2016 Jan 28.
PURPOSE: Calcific discitis is a self-limiting process most commonly seen in the cervical spine of children. Rare literature exists regarding the natural history and management of this condition in adults, especially when it presents as a giant thoracic disc herniation into the spinal canal. Giant herniations in the thoracic spine are typically surgically removed to reduce the chance of permanent neurologic deficit from spinal cord compression. However, when associated with calcific discitis, they may undergo spontaneous regression with the need for surgery obviated. METHODS: Medical records and radiographic studies of two adult patients with calcific discitis and myelopathy due to spinal cord compression by giant thoracic disc herniations were retrospectively reviewed. Search of the literature on calcific discitis in adults and spontaneous regression of calcified thoracic disc herniations was separately performed. RESULTS: Both patients were young male adults presenting with back pain and early signs of myelopathy. With restriction of activities and oral NSAIDs, their symptoms were relieved within 3 months. Four adult cases of calcific discitis (characteristic central calcification confined within the nucleus pulposus) and three instances of spontaneous regression of small- to medium-sized thoracic calcified disc herniations were identified from the literature. CONCLUSIONS: The demonstration of spontaneous resorption of giant calcified thoracic disc herniations in two adult patients with calcific discitis supplements the existing literature and provides the first evidence that giant calcified thoracic disc herniations may still undergo spontaneous remission and a "wait and watch" strategy may be justified at least in the initial management of these patients, even with the presence of mild myelopathy.
目的:钙化性椎间盘炎是一种自限性疾病,最常见于儿童颈椎。关于成人这种疾病的自然病程和治疗的文献很少,尤其是当它表现为巨大的胸椎间盘突出进入椎管时。胸椎的巨大突出通常通过手术切除,以减少脊髓受压导致永久性神经功能缺损的机会。然而,当与钙化性椎间盘炎相关时,它们可能会自发消退,无需手术。 方法:回顾性分析了两名因巨大胸椎间盘突出压迫脊髓导致钙化性椎间盘炎和脊髓病的成年患者的病历和影像学研究。分别检索了关于成人钙化性椎间盘炎和钙化胸椎间盘突出自发消退的文献。 结果:两名患者均为年轻男性成年人,表现为背痛和脊髓病的早期症状。通过限制活动和口服非甾体抗炎药,他们的症状在3个月内得到缓解。从文献中确定了4例成人钙化性椎间盘炎(特征性中央钙化局限于髓核内)和3例中小型钙化胸椎间盘突出自发消退的病例。 结论:两名患有钙化性椎间盘炎的成年患者中巨大钙化胸椎间盘突出自发吸收的表现补充了现有文献,并提供了首个证据,即巨大钙化胸椎间盘突出仍可能自发缓解,至少在这些患者的初始治疗中,即使存在轻度脊髓病,“观察等待”策略也可能是合理的。
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