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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Case of the Month

Section Editor: Nicholas Stence, MD
Children's Hospital Colorado, Aurora, CO

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July 2023
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Next Case of the Month Coming August 8...

Adult-Onset Acute Calcific Discitis

  • Background:
    • Acute calcific discitis is a rare condition of unknown etiology observed usually in childhood. However, there have been a few cases described in the adult population.
    • The most common hypothesis is the presence of a vascular insult, which could eventually lead to discal calcification by interrupting blood supply to the nucleus pulposus.
    • In adults, this condition is more often located at the middle or lower thoracic spine, while cervical localization is more frequently encountered in children.
    • The diagnosis of acute calcific discitis must be recognized early to avoid discovertebral biopsy or antibiotics use.
  • Clinical Presentation:
    • Sudden onset of severe spine pain with or without fever and/or elevated inflammatory parameters
    • Remission of symptoms following resolution of herniated calcified nucleus pulposus is common within a few days or weeks.
  • Key Diagnostic Features:
    • Bone edema:
      • MRI: low signal intensity on T1, high signal on T2/STIR images, and intense enhancement after gadolinium administration
    • Calcification:
      • CT: intradiscal calcium density content, usually migrated to adjacent vertebral body through a bony defect of the inferior endplate
      • MRI: intradiscal and inferior endplate lesion of very low signal in all sequences representing calcification
  • Differential Diagnoses:
    • Infection
    • Neoplastic involvement of vertebral body
    • Other inflammatory diseases
  • Treatment:
    • Patients usually experience complete resolution of symptoms after a few days or weeks with conservative treatment with anti-inflammatory drugs and rest.

Suggested Reading

  1. lampreechakul 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;14:1021–29
  2. Choueiri M, Eymard F, Guignard S, et al. Acute symptomatic calcific discitis mimicking a septic spondylodiscitis. Case Rep Rheumatol 2020;2020:5454197
  3. Lazarou I, Farracho LC, Genevay S, et al. Adult-onset acute calcific discitis. J Rheumatol 2022;49:330–31

Current Issue

American Journal of Neuroradiology: 46 (7)
American Journal of Neuroradiology
Vol. 46, Issue 7
1 Jul 2025
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