| The clinical features of patients with large calcified lumbar disc herniations differ from those with noncalcified herniations. In general, these patients are older than the average patients with non-calcified herniations. They presented with more chronic symptoms and longer periods of back and/or leg pain. Although the lesions may be large, the symptoms seemed to be better tolerated than non-calcified disc herniations of similar size. This condition is found in all racial groups, more commonly in Asians. Vascular calcification was noted in 51% of the patients. Multiplanar CT scans showed that most of the calcification in lumbar disc herniations began peripherally and progressed internally in follow-up studies.
Review of 1159 lumbar spine CT scans of patients with back and/or leg pain showed 82 with calcified disc protrusions. There were 33 patients wit
partially or totally calcified posterior disc herniations or extrusions of more than 5mm, ranging from 6mm to 15mm. There were 17 males and 16 females. Age ranged from 24 to 68 with a mean of 56. There were 26 caucasians, one black and six Asians. Asians comprised 18.2% of the total; however, they represented only about 7% of all patients seen. Symptoms duration was 2 weeks to 35 years of low back and/or leg pain with mean of 8.4 years. Vascular calcification was visualized on CT scan anterior to the lumbar spine in 17 patients or 51.5% of patients. 87.9% presented with pain on lumbar flexion and/or sitting. 12.1% presented with stenotic symptoms with lumbar extension and/or walking. Neurological deficits were found in 7. There were 20 patients with L5-S1, 6 with L4-5, 6 with L3-4, and one with L2-3 disc involvement. Six had calcified disc herniations at one level and smaller calcified disc protrusion at additional levels. The pattern of calcification is more frequently in the periphery of the disc herniation or extrusion. 23 of the 33 disc herniations and extensions were noted to be in the periphery. Ten patients had calcification internally within the herniated or extruded disc fragments. Peripheral to internal progression in the disc calcification was noted on follow-up CT scan in two, one over 5 years, and the other over 4 years. Patients with calcification internally within herniated or extruded disc fragments or with complete calcification or ossification presented with 5 to 16 years of chronic symptoms. Surgical decompression was recommended to 13 patients. However, 9 of them refused surgery. Three underwent surgical decompressions and discectomies with two obtaining good relief of both the back and leg pain. Only leg pain resolved with persistence of back pain in one. One patient improved following decompression and fusion. Improvement in symptoms was noted in 58% of patients who received non-surgical treatment with exercise program and epidural blocks. |
