Summary Pediatric Intervertebral Disc Calcification is a very rare condition of unknown etiology. Textbook presentation is child with neck pain, fever, malaise, and an elevated ESR and presumably CRP. Treatment is typically conservative, and the disease is usually self-limiting with a favorable prognosis Epidemiology Incidence <0.01% Demographics 2:1 male to female ratio 6-10 years Location classically cervical spine typical location lower cervical spine, specifically C6-C7, however can occur anywhere in the spine thoracic, lumbar, and multiple level involvement have been rarely Risk factors unknown Etiology Pathophysiology unknown possible pathophysiology causes: trauma inflammatory or infectious etiopathogenetic aseptic necrosis disorders of vitamin D metabolism abnormal blood supply Genetics no known genetic pattern Anatomy Intervertebral disc annulus nucleus pulposus Classification Single vs. Multiple Disc Levels Symptomatic vs. Asymptomatic Presentation Symptoms neck pain (67-80%) may present as acute, subacute, and chronic pain torticollis (20-22%) stiffness low grade fever (10%) weakness (rare) Physical exam inspection torticollis motion limited range of motion (14-33%) neurovascular neurological deficit (11-38% according to some series, but in reality this is rare) Imaging Radiographs recommended views AP and lateral findings calcificaiton of the disc may appear as dense round or oval mass in the nucleus pulposus, or may be difusse calcification of the disc at one or more discs CT indications may be used to rule out congenital fusion MRI indications neurologic deficits concern for disc herniation findings diminished signal intensity on MRI Studies Labs ESR CRP Differential Congenital Fusion/Klippel-Feil Syndrome (KFS) classic triad short webbed neck low posterior hairline limited cervical range of motion Atlantoaxial rotatory subluxation post-traumatic or post infectious (Grisel’s disease) Treatment Nonoperative observation indications standard of care unless for vast majority of case modalities analgesic and anti-inflammatory medications neck collar outcomes symptomatic improvement after several 95% of patients have resolution within 6 months of presentation radiographic resolution lags behind clinical resolution my many months at least Operative neurologic decompression indications neurologic deficits with mass effect on spinal cord intractable pain Complications Neurologic deficits (either nerve root or spinal cord) incidence extremely rare may be associated with lesions in the annulus fibrosus Prognosis Natural history generally accepted as self-limiting and has an excellent prognosis