1. Imaging Findings

Based on the provided cervical spine X-ray and MRI, an oval or round calcified shadow can be seen in the intervertebral space of the lower cervical spine (e.g., C5-C6 or adjacent vertebrae), located in the disc region, appearing as a dense or signal-loss area. On MRI, both T1- and T2-weighted images show significantly reduced signal, suggesting possible calcium salt deposition or a harder lesion in this region. The surrounding vertebral structures appear largely intact, without evident fractures or bony destruction, and no obvious soft tissue swelling or other abnormalities.

2. Potential Diagnoses

• ① Pediatric Cervical Intervertebral Disc Calcification (Calcific Discitis)
  Major basis:
  • The child is relatively young (approximately 9 years old), which corresponds to the common age of onset.
  • Calcification often occurs in the lower cervical disc, with imaging showing an elliptical dense lesion in the disc area.
  • Often associated with acute neck pain and limited range of motion, without trauma or obvious signs of inflammation.
• ② Degenerative Disc Calcification
  Major basis:
  • Common among adults but extremely rare in children. If considered, a history of trauma or long-term abnormal stress should be evaluated.
  • Usually appears in adults as part of cervical spine degeneration, with imaging findings such as narrowed disc space and osteophyte formation.
• ③ Infectious Lesion (e.g., Discitis)
  Major basis:
  • Possible vertebral endplate destruction, paravertebral soft tissue swelling, or other infection indicators.
  • This case shows no obvious bone destruction or local signs of infection, making this diagnosis less likely.

3. Final Diagnosis

Considering the clinical presentation (acute neck pain, no previous history of trauma), imaging features (calcified lesion in the disc region with low signal on both T1- and T2-weighted images), and the patient’s age, the most likely diagnosis is: Pediatric Cervical Intervertebral Disc Calcification (Calcific Discitis).

4. Treatment Plan and Rehabilitation Program

Treatment Strategy:
1) Conservative management is the main approach: Generally, surgery is not required. NSAIDs (non-steroidal anti-inflammatory drugs) are used to relieve pain and inflammation, and a soft cervical collar is recommended to temporarily stabilize the neck and reduce disc pressure.
2) Observation and follow-up: Over time, pediatric cervical disc calcifications often resolve spontaneously, with symptoms typically improving within a few weeks to months.
3) If symptoms persist despite conservative treatment or if signs of nerve compression (e.g., numbness, weakness in the upper limbs) arise, further imaging evaluation and orthopedic consultation should be considered.

Rehabilitation/Exercise Prescription:
1) Immediate Rest Period (acute phase, around 1–2 weeks): Focus on protecting the affected area and alleviating symptoms. Perform only gentle neck stretches and circular motions, avoiding strenuous activities or weight-bearing exercises.
2) Gradual Activity Phase (after pain relief): Under professional guidance, engage in mild cervical spine strengthening and flexibility exercises, such as small-range flexion, extension, and rotation, along with isometric exercises for the shoulder girdle and upper back muscles. Each session lasts 15–20 minutes, 3–4 times per week, at an intensity that does not cause significant pain.
3) Stabilization Phase (after complete symptom resolution): Gradually increase exercise duration and intensity (following the FITT-VP principles: Frequency, Intensity, Time, Type, Volume/Progression). If no specific contraindications exist, cervical and shoulder strength training (resistance bands, low-weight dumbbells) and aerobic exercises (swimming, cycling) can be introduced 1–2 months later. A frequency of 3–5 training sessions per week, each lasting about 30 minutes, with gradual progression is recommended.
4) Precautions: Throughout rehabilitation, adjustments should be made based on the child’s exercise tolerance, skeletal maturity, and physical condition to ensure safety. If severe pain, posture changes, or neurological symptoms develop, seek medical attention and reevaluation promptly.