Giant calcified lumbar disc herniation in post-operative adjacent segment degeneration: a case report

Giant, calcified disc herniation is a rare type of intervertebral disc calcification and herniation where a large calcified, herniated disc occupies more than 40% of the spinal canal. Cases of giant, calcified disc herniations have been reported primarily in the thoracic spine in adults. They are associated with more symptomatic disc disease and can pose surgical challenges. However, little is known about their occurrence in the lumbar spine, especially in association with prior spine surgeries. The aim of this case report is to describe clinical findings and management of rare, giant, calcified disc herniation presenting as adjacent level degeneration in the lumbar spine.

A 75-year-old man with several previous lumbar spine surgeries, including posterior instrumented fusion at L3-S1, presented with a 5-week history of progressive bilateral lower extremity weakness. Lumbar spine magnetic resonance imaging (MRI) and computed tomography (CT) revealed a large, calcified intraspinal mass in the right paracentral region at L2-L3, adjacent to the prior surgical levels. It resulted in severe narrowing of the right lateral recess. This lesion was new when compared to the lumbar spine MRI performed 6 months prior. The lesion was surgically resected without complications, and the pathology revealed a degenerating disc with bone fragments and calcifications.

This case demonstrates an unusual presentation of a giant, calcified disc herniation in the lumbar spine as a component of adjacent segment degeneration in a patient with prior lumbar spine surgeries. The case illustrates the dynamic nature of intervertebral disc herniations and calcifications as well as management considerations.