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Cotten A, Henry S, Scarciolla L, Abou Diwan R, Demondion X, Badr S. Crystal Diseases of the Spine. Semin Musculoskelet Radiol 2023; 27:545-552. [PMID: 37816362 DOI: 10.1055/s-0043-1770763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
Gout, calcium pyrophosphate deposition disease, and apatite calcifications, the three main crystal disorders, may involve the spine. These disorders can be completely asymptomatic or associated with various clinical symptoms, such as acute flares and more chronic manifestations. This article presents the typical and more unusual imaging features encountered in these disorders.
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Affiliation(s)
- Anne Cotten
- CHU Lille, Service de Radiologie et Imagerie Musculosquelettique, Lille, France
- University of Lille, MABlab ULR 4490, Lille, France
| | - Simon Henry
- CHU Lille, Service de Radiologie et Imagerie Musculosquelettique, Lille, France
| | - Laura Scarciolla
- CHU Lille, Service de Radiologie et Imagerie Musculosquelettique, Lille, France
| | - Ralph Abou Diwan
- CHU Lille, Service de Radiologie et Imagerie Musculosquelettique, Lille, France
| | - Xavier Demondion
- CHU Lille, Service de Radiologie et Imagerie Musculosquelettique, Lille, France
- University of Lille, CHU Lille, Unité de Taphonomie Médicolégale & d'Anatomie, Lille, France
| | - Sammy Badr
- CHU Lille, Service de Radiologie et Imagerie Musculosquelettique, Lille, France
- University of Lille, MABlab ULR 4490, Lille, France
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Yuan L, Chen Z, Liu Z, Li W, Sun C, Liu X. Clinical and radiographic features of adult calcified thoracic disc herniation: a retrospective analysis of 31 cases. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:2387-2395. [PMID: 37222802 DOI: 10.1007/s00586-023-07784-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 04/18/2023] [Accepted: 05/14/2023] [Indexed: 05/25/2023]
Abstract
PURPOSE To analyze the clinical and radiographic characteristics of calcified thoracic disc herniation (CTDH) and explore the possible pathogeneses. METHODS This is a retrospective clinical review of prospectively collected imaging data based at a single institute from 2004 to 2021. Clinical and radiographic parameters of CTDH patients were retrospectively collected and analyzed. RESULTS All 31 patients included presented thoracic myelopathy with a 17.05-month preoperative disease duration. Three (9.7%) patients had a history of trauma, and the rest had insidious onset. The average spinal canal ventral-occupying ratio was 74.90 ± 15.16%. The most prominent radiographic feature was the calcification of the nucleus pulposus in the intervertebral disc and the calcified lesion contiguous with the disc space protruding into the spinal canal. Three main imaging forms of CTDH were found: calcium-ringed lesion (5), heterogeneous calcification lesion (19), and homogeneous calcification lesion (7). The radiographic manifestations, intraoperative findings, and postoperative pathologies of the three subtypes were different. The calcium-ringed lesion type was younger and had a shorter preoperative duration and significantly lower mJOA score. A special case was observed conservatively for five years, which suggested that a heterogeneous lesion could progress to a homogeneous lesion. CONCLUSIONS Adult CTDH is a special thoracic disc disease with insidious onset, a long course, and a high spinal canal-occupying ratio. Calcium deposits in the spinal canal originate from the nucleus pulposus. The intraoperative findings and postoperative pathology of subtypes are different, which might indicate different pathological mechanisms.
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Affiliation(s)
- Lei Yuan
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Street, Hai Dian, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, 49 North Garden Road, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, 49 North Garden Road, Beijing, 100191, China
| | - Zhongqiang Chen
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Street, Hai Dian, Beijing, 100191, China.
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, 49 North Garden Road, Beijing, 100191, China.
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, 49 North Garden Road, Beijing, 100191, China.
| | - Zhongjun Liu
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Street, Hai Dian, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, 49 North Garden Road, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, 49 North Garden Road, Beijing, 100191, China
| | - Weishi Li
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Street, Hai Dian, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, 49 North Garden Road, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, 49 North Garden Road, Beijing, 100191, China
| | - Chuiguo Sun
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Street, Hai Dian, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, 49 North Garden Road, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, 49 North Garden Road, Beijing, 100191, China
| | - Xiaoguang Liu
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Street, Hai Dian, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, 49 North Garden Road, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, 49 North Garden Road, Beijing, 100191, China
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Wan ZY, Shan H, Liu TF, Song F, Zhang J, Liu ZH, Ma KL, Wang HQ. Emerging Issues Questioning the Current Treatment Strategies for Lumbar Disc Herniation. Front Surg 2022; 9:814531. [PMID: 35419406 PMCID: PMC8999845 DOI: 10.3389/fsurg.2022.814531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 03/04/2022] [Indexed: 11/26/2022] Open
Abstract
Lumbar disc herniation is among the common phenotypes of degenerative lumbar spine diseases, significantly affecting patients' quality of life. The practice pattern is diverse. Choosing conservative measures or surgical treatments is still controversial in some areas. For those who have failed conservative treatment, surgery with or without instrumentation is recommended, causing significant expenditures and frustrating complications, that should not be ignored. In the article, we performed a literature review and summarized the evidence by subheadings to unravel the cons of surgical intervention for lumbar disc herniation. There are tetrad critical issues about surgical treatment of lumbar disc herniation, i.e., favorable natural history, insufficient evidence in a recommendation of fusion surgery for patients, metallosis, and implant removal. Firstly, accumulating evidence reveals immune privilege and auto-immunity hallmarks of human lumbar discs within the closed niche. Progenitor cells within human discs further expand the capacity with the endogenous repair. Clinical watchful follow-up studies with repeated diagnostic imaging reveal spontaneous resolution for lumbar disc herniation, even calcified tissues. Secondly, emerging evidence indicates long-term complications of lumbar fusion, such as adjacent segment disease, pseudarthrosis, implant failure, and sagittal spinal imbalance, which get increasing attention. Thirdly, systemic and local reactions (metallosis) for metal instrumentation have been noted with long-term health concerns and toxicity. Fourthly, the indications and timing for spinal implant removal have not reached a consensus. Other challenging issues include postoperative lumbar stiffness. The review provided evidence from a negative perspective for surgeons and patients who attempt to choose surgical treatment. Collectively, the emerging underlying evidence questions the benefits of traditional surgery for patients with lumbar disc herniation. Therefore, the long-term effects of surgery should be closely observed. Surgical decisions should be made prudently for each patient.
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Affiliation(s)
- Zhong Y. Wan
- Department of Orthopedics, The Seventh Medical Center of General Hospital of People's Liberation Army (PLA), Beijing, China
| | - Hua Shan
- Institute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xi'an, China
| | - Tang F. Liu
- Institute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xi'an, China
| | - Fang Song
- Department of Stomatology, The Specialty Medical Center Rocket Force of People's Liberation Army (PLA), Beijing, China
| | - Jun Zhang
- Department of Orthopedics, Baoji Central Hospital, Baoji, China
| | - Zhi H. Liu
- Department of Cardiac Surgery, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Kun L. Ma
- Department of Orthopedics, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Hai Q. Wang
- Institute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xi'an, China
- *Correspondence: Hai Q. Wang ;
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Radiographic and clinical features of thoracic disk disease associated with myelopathy: a retrospective analysis of 257 cases. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2211-2220. [PMID: 33389202 DOI: 10.1007/s00586-020-06688-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/11/2020] [Accepted: 11/28/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To analyze the clinical and radiographic characteristics of thoracic disk disease associated with myelopathy (TDM). METHODS This is a retrospective clinical review of prospectively collected imaging data based at a single institute. Based on preoperative CT and MRI, we classified TDM as thoracic disk herniation (TDH), THD with ossification (THDO), TDH with posterior bony avulsions of the vertebrae (TDH with PBA), TDH with posterior vertebral osteophytes (TDH with PVO), giant thoracic osteophyte and calcific discitis with herniation (CDH). Patient characteristics and radiographic data were compared between different types of TDM. RESULTS Among the 257 patients included, 12.06% of patients presented with symptoms after traumatic events. The most frequent complaint at onset and preoperative was back pain (29.2%) and subjective lower limb weakness (75.5%), respectively. All TDH with PBA is distributed at the lower thoracic segments, while CDH predominantly in the middle and lower thoracic segments. TDH with PBA was more frequent in men than TDH and CDH. Compared with TDH, TDHO, and TDH with PVO, TDH with PBA was younger in surgery age, and TDH and CDH had lower preoperative JOA scores than TDH with PBA. CDH had a larger ventral occupying ratio than TDH, TDHO, and TDH with PBA. CONCLUSIONS The onset of TDM was generally insidious but may be triggered acutely by apparently trivial events. With a low prevalence, TDM varied clinical symptoms. Different types of TDM had various clinical features, which might indicate different pathological mechanisms.
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Schulze P, O’Connor C, Anand N, Wynne P. A Rare Cause of Acute Back Pain in a Young Adult: Case Report and Discussion of Calcific Discitis. J Radiol Case Rep 2020; 14:1-9. [PMID: 33708337 PMCID: PMC7942968 DOI: 10.3941/jrcr.v14i10.3728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Calcific discitis in the adult population is very rare, with fewer than 40 cases reported in the literature. Most cases thus far have involved patients presenting with mid to upper back pain of acute to subacute onset. As it is a condition that is self-resolving with rare exception, the true incidence is likely underestimated. Another factor contributing to the underestimation of individuals with back pain in general is that many patients will treat themselves before presenting for care. Back pain is one of the most common presenting symptoms to primary care physician offices and represents an economic burden of billions of dollars annually. The utilization of MRI imaging and other diagnostic work-up amount to an important component of this cost and one that could possibly be reduced with early radiological identification of this condition. We present a case in which an adult patient presented with subacute lumbar back pain, eventually diagnosed as calcific discitis.
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Affiliation(s)
- Paul Schulze
- Department of Radiology, Morristown Medical Center, Morristown, NJ
| | | | - Neil Anand
- Department of Radiology, Morristown Medical Center, Morristown, NJ
| | - Peter Wynne
- Department of Radiology, Morristown Medical Center, Morristown, NJ
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Acute Symptomatic Calcific Discitis Mimicking a Septic Spondylodiscitis. Case Rep Rheumatol 2020; 2020:5454197. [PMID: 32231841 PMCID: PMC7085383 DOI: 10.1155/2020/5454197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 01/29/2020] [Accepted: 02/11/2020] [Indexed: 11/17/2022] Open
Abstract
Acute symptomatic calcific discitis is a poorly understood condition that has been mostly reported in children. Cases in adults have been scarcely reported and may mimic an infectious process. Imaging, including computed tomography, can show the disc calcification but might fail to show it because its resorption can occur early after the onset of symptoms. We report the case of an adult patient presenting with severe cervical-dorsal junction pain, fever, high C-reactive protein (CRP) levels, and imaging findings mimicking an infectious spondylodiscitis, including an erosion of the anterior part of the vertebral endplate. However, the patient improved spontaneously and rapidly, with pain and fever disappearing and C-reactive protein (CRP) returning to normal within a week.
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Iampreechakul P, Lertbutsayanukul P, Suanprasert N. Acute Calcific Discitis or Symptomatic Calcified Schmorl's Node of the Upper Thoracic Spine in an Adult: A Case Report and Literature Review. Asian J Neurosurg 2019; 14:1021-1029. [PMID: 31497157 PMCID: PMC6703016 DOI: 10.4103/ajns.ajns_119_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We describe a patient with acute calcific discitis following symptomatic Schmorl's node (SN) of upper thoracic spine. A 28-year-old female suffered from sudden severe pain in mid-thoracic, left scapular area, radiating to her chest. Plain radiography of the thoracic spine showed calcification in T3–4 intervertebral disc space. Computed tomography (CT) scan and magnetic resonance imaging (MRI) of the spine demonstrated calcification of the T3–T4 nucleus pulposus, migrating into the inferior of T3 vertebral body with reactive bone marrow edema. By conservative treatment with multidrug therapy, the pain subsided and disappeared in 3 months. Follow-up CT scan and MRI of the thoracic spine confirmed complete resolution of calcified SN and reactive bone marrow edema.
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What are the possibilities of spontaneous resorption of a thoracic disc herniation occupying more than 20% of the spinal canal in the asymptomatic subject? Comparative study. J Clin Neurosci 2017; 44:269-273. [DOI: 10.1016/j.jocn.2017.06.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 06/18/2017] [Indexed: 11/18/2022]
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Giant thoracic discs: treatment, outcome, and follow-up of 33 patients in a single centre. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:1555-1566. [DOI: 10.1007/s00586-017-5192-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 06/03/2017] [Accepted: 06/11/2017] [Indexed: 10/19/2022]
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