Recurrent Multilevel Calcified Lumbar Disk Herniation Successfully Managed by Lumbar Spinal Fusion: A Rare Case Report.

Introduction: Calcified lumbar disk herniation (LDH) is a rare subtype of LDH, and recurrent multilevel presentations in adults have not been reported. Its optimal management remains unclear, especially in cases resistant to standard decompression and discectomy. Case Report: A 58-year-old woman presented with a 6-month history of bilateral lower extremity pain, numbness, and intermittent claudication, with walking limited to 10-20 m. Magnetic resonance imaging revealed L4/5 spinal canal stenosis without evidence of disk calcification on computed tomography. Posterior decompression at L4/5 resulted in significant symptom improvement. Two years later, right leg pain developed after a fall, and imaging confirmed a calcified disk herniation at L3/4 compressing the L4 nerve root. Discectomy provided complete relief. Three months later, a calcified herniation at L5/S1 extended bilaterally, compressing both S1 nerve roots. Discectomy was performed, and histopathology confirmed calcium pyrophosphate dihydrate deposition. One month later, recurrent bilateral symptoms occurred, with imaging revealing a new calcified herniation at L2/3 and a persistent fluid-filled herniation sac at L5/S1. Surgical treatment relieved the L2/3 lesion but not the L5/S1 findings. Subsequent recurrence at L1/2 prompted staged spinal fusion: lateral lumbar interbody fusion from L2/3 to L4/5, followed by posterior fusion from T10 to the pelvis. At 1-year follow-up, no new herniations were observed, and symptoms remained controlled. Conclusion: Recurrent multilevel calcified lumbar disk herniation is exceptionally rare and may be refractory to conventional decompression and discectomy. In such cases, extensive spinal fusion can be an effective strategy to prevent recurrence and achieve long-term symptom resolution.