From the Guidelines
Schmorl's nodes are small depressions or herniations in the endplates of the vertebrae, typically in the thoracic and lumbar spine, where the intervertebral disc tissue protrudes into the adjacent vertebral body 1. They are often associated with degenerative disc disease and can be a cause of back pain.
Characteristics of Schmorl's Nodes
- Typically found in the thoracic and lumbar spine
- Appear as well-defined, rounded or oval lesions in the vertebral endplates on imaging studies, such as MRI or CT scans
- Can be caused by mechanical loading and impact stress on the lower spine, such as that experienced by horseback riders 1
Treatment Options
- Treatment usually focuses on managing symptoms, such as pain and inflammation, with medications like acetaminophen or ibuprofen
- Physical therapy can help improve spinal mobility and strength
- In some cases, more advanced treatments like epidural injections or surgery may be necessary to alleviate symptoms
Associated Conditions
- Osteoarthritis of vertebral joint facets
- Spondylolysis, a defect in the neural arch
- Degenerative changes to the spine, particularly lumbar vertebrae 1
From the Research
Definition and Description of Schmorl's Nodes
- Schmorl's nodes (SN) are defined as the herniation of nucleus pulposus through the cartilaginous and bony endplate into the body of the adjacent vertebra 2.
- They are also described as a focal herniation of intervertebral disc through the end plate into the vertebral body 3.
- SNs are common findings on imaging, and although most SNs are asymptomatic, some have been shown to become painful lesions 2.
Epidemiology and Clinical Significance
- Debate continues about the epidemiology, physiopathology, and clinical significance of SNs 4.
- SNs are frequent vertebral defects at the thoracolumbar juncture, with ethnic and gender influence 4.
- Lumbar Schmorl's nodes are frequently associated with disc degenerative disease and back pain 4.
- SNs could be associated with intervertebral disc degeneration at upper lumbar levels and end-plate disease at lower lumbar level in patients with low back pain 5.
Pathogenesis and Management
- The pathogenesis of SNs remains unknown, but strain energy changes in the spine, morphological aspects of the vertebra, genetic background, and osteoimmunology may constitute possible clues 4.
- Symptomatic SNs are thought to be due to the inflammatory response solicited by the herniation of nucleus pulposus into the well-vascularized vertebral body 2.
- Management options for symptomatic SNs vary, ranging from medical management to surgical fusion 2.
- Transforaminal epidural block is suggested as a first conservative option to treat radicular pain due to herniation of intervertebral disc 3.