From the Guidelines
Schmorl's nodes are herniations of the intervertebral disc material through the vertebral endplate into the adjacent vertebral body and are often associated with mechanical loading and impact stress on the lower spine, particularly in individuals who engage in activities such as horseback riding or chariotry 1.
Definition and Significance
Schmorl's nodes are significant because they can be indicative of underlying spinal degeneration or trauma, and their presence may be associated with pain and discomfort in some individuals. The development of Schmorl's nodes is thought to be related to increased axial pressure on the spine, which can cause the softer disc material to herniate through weakened areas in the vertebral endplate 1.
Treatment and Management
Treatment for Schmorl's nodes is primarily conservative and symptom-based, with a focus on managing pain and preventing further degeneration 1. For patients experiencing pain, over-the-counter pain medications like acetaminophen or NSAIDs such as ibuprofen are typically first-line treatments. Physical therapy focusing on core strengthening exercises and proper body mechanics is also recommended. Activity modification to avoid heavy lifting and high-impact activities may be necessary during the acute pain phase. Heat or ice application can provide additional relief, and for severe pain, prescription medications like muscle relaxants or short-term opioids might be considered.
Follow-up and Prognosis
Most Schmorl's nodes stabilize over time without surgical intervention, and surgery is rarely indicated unless there are complications like significant vertebral collapse or neurological symptoms 1. Regular follow-up with a healthcare provider is important to monitor the progression of the condition and adjust treatment as needed. Lifestyle modifications, such as maintaining a healthy weight, engaging in regular exercise, and avoiding heavy lifting, can also help to prevent further degeneration and reduce the risk of developing Schmorl's nodes.
Key Points
- Schmorl's nodes are herniations of the intervertebral disc material through the vertebral endplate into the adjacent vertebral body
- Associated with mechanical loading and impact stress on the lower spine
- Treatment is primarily conservative and symptom-based
- Focus on managing pain and preventing further degeneration
- Regular follow-up with a healthcare provider is important to monitor progression and adjust treatment as needed
From the Research
Definition and Significance of Schmorl's Node
- Schmorl's nodes are herniations of nucleus pulposus through the cartilaginous and bony endplate into the adjacent vertebra 2.
- They are extremely common and are typically seen as incidental findings on radiographic imaging, with an estimated prevalence of greater than 70% in the population 2.
- Schmorl's nodes can be a cause of acute back pain and, even less often, radiculopathy, although this is rare 2, 3.
Treatment of Schmorl's Node
- The mainstay of treatment for Schmorl's nodes is conservative therapy, although surgical removal of disc material has been successful in cases of persistent radiculopathy from compression by a tunneling Schmorl's node 2.
- Percutaneous vertebroplasty has also been used to treat painful Schmorl nodes, with improvement reported in 18 out of 23 patients in one study 3.
- Management options for symptomatic Schmorl's nodes vary, ranging from medical management to surgical fusion, although there is no established treatment modality 4.
Association with Intervertebral Disc Degeneration and End-plate Disease
- Schmorl's nodes have been associated with intervertebral disc degeneration at upper lumbar levels and end-plate disease at lower lumbar levels in patients with low back pain 5.
- Higher Schmorl's node scores have been linked to an increased risk of severe intervertebral disc degeneration at corresponding lumbar levels 5.
- Body weight has been identified as a significant factor associated with the presence of Schmorl's nodes, while severe intervertebral disc degeneration at the L5-S1 level is a significant factor associated with the intensity of low back pain 5.