Heterotopic calcification in a child presenting as acute on chronic myelopathy

Heterotopic calcification (HC) is a rarely reported pathology of aberrant bone deposition in extraskeletal tissue, most commonly outside of the central nervous system. While some of these findings may be incidental and asymptomatic, patients with symptomatic cord compression due to HC require consideration for expedited surgical intervention. We present the first described pediatric case of HC of the cervical spine causing spinal cord compression in a patient presenting with acute weakness and paresthesias following a minor trauma.

An 11-year-old male with a history of long-standing spastic hemiplegia thought to be related to perinatal hypoxia presented acutely myelopathic after a minor trauma. Imaging revealed an extradural calcification of the upper cervical spine with severe spinal cord compression and a focal kyphotic deformity, considered most likely to represent a calcified meningioma, nerve sheath tumor, or heterotopic calcification. The patient was taken for decompression, mass resection, and laminoplasty, with final pathology revealing heterotopic calcification.

While HC can develop after traumatic insult, or as late sequelae of spontaneous hemorrhage or infection, involvement of the cervical spine in a child has not previously been reported. In the setting of severe spinal cord compression with motor deficits, decompression and complete resection are safe and feasible. Histological analysis of HC will demonstrate a zonal arrangement of peripheral spindle cells/fibrous tissue, myxoid/cartilaginous tissue, and an inner core of ossification. Close attention should be paid in infancy when there may be an unclear diagnosis for weakness or spasticity without full imaging of the neuroaxis.