What are Schmorl's nodes?

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 herniations of nucleus pulposus through the cartilaginous and bony endplate into the adjacent vertebra 2, 3, 4, 5.
• They are characterized by the protrusion of intervertebral disc material into the vertebral body, which can be asymptomatic or symptomatic 3, 4.

Epidemiology and Prevalence

• Schmorl's nodes are extremely common, with an estimated prevalence of over 70% in the population, often found incidentally on radiographic imaging 3.
• They can be found in both symptomatic and asymptomatic individuals, with a higher prevalence in certain ethnic and gender groups 2.

Clinical Significance and Association with Back Pain

• Schmorl's nodes have been associated with back pain, particularly in cases where the node compresses adjacent nerve roots or causes inflammation 3, 4, 6.
• The presence of Schmorl's nodes has been linked to intervertebral disc degeneration, especially at upper lumbar levels, and end-plate disease at lower lumbar levels in patients with low back pain 6.

Diagnosis and Imaging

• Magnetic Resonance Imaging (MRI) is the imaging modality of choice for diagnosing Schmorl's nodes, as it can detect edema, neovascularization, and extruded disc material 3.
• Other imaging techniques, such as X-rays and CT scans, may also be used to visualize Schmorl's nodes, but MRI is preferred for its higher sensitivity and specificity 5.

Treatment and Management

• Conservative therapy is the mainstay of treatment for Schmorl's nodes, with surgical removal of disc material reserved for cases of persistent radiculopathy or severe symptoms 3, 4.
• The management of symptomatic Schmorl's nodes varies, ranging from medical management to surgical fusion, with no established treatment modality for all cases 4.