From the Guidelines
A Schmorl's node is a protrusion of intervertebral disc material into the vertebral body, often associated with mechanical loading and impact stress on the lower spine, as seen in activities such as horseback riding 1. This occurs when the soft inner core of a spinal disc (nucleus pulposus) herniates through the cartilage endplate and into the adjacent vertebral body. Schmorl nodes are relatively common findings on imaging studies and are often discovered incidentally when X-rays, CT scans, or MRIs are performed for other reasons. Most Schmorl nodes are asymptomatic and require no treatment. However, in some cases, particularly when they form acutely, they can cause localized back pain. Treatment for symptomatic Schmorl nodes typically involves conservative measures such as rest, physical therapy, anti-inflammatory medications like ibuprofen or naproxen, and occasionally muscle relaxants. These nodes form due to weaknesses in the vertebral endplate, often related to developmental factors, degenerative changes, or trauma, as noted in a study on the biomechanical stressors of different animal transport strategies 1. The pressure from the disc material causes the nucleus pulposus to herniate into the vertebral body, creating the characteristic appearance on imaging. While most Schmorl nodes are benign findings, they can occasionally be associated with conditions like Scheuermann's disease or osteoporosis, and may also be related to activities that involve mechanical loading and impact stress on the lower spine, such as horseback riding or chariotry 1. Some key points to consider about Schmorl's nodes include:
- They are a type of vertebral lesion that can be associated with back pain
- They are often discovered incidentally on imaging studies
- They can be related to developmental, degenerative, or traumatic factors
- They may be associated with conditions like Scheuermann's disease or osteoporosis
- Conservative treatment measures are often effective in managing symptoms.
From the Research
Definition of Schmorl's Node
- A Schmorl's node is a herniation of the nucleus pulposus through the cartilaginous and bony endplate into the adjacent vertebra 2.
- It is a focal herniation of intervertebral disc through the end plate into the vertebral body 3.
Prevalence of Schmorl's Nodes
- Schmorl's nodes are extremely common and are typically seen as incidental findings on radiographic imaging 2.
- It is estimated that greater than 70% of the population has Schmorl's nodes, based on postmortem studies 2.
Symptoms of Schmorl's Nodes
- Schmorl's nodes are usually asymptomatic, but can cause acute back pain and radiculopathy in rare cases 2, 4, 3.
- The pain can be severe and debilitating, and may be accompanied by other symptoms such as paraspinal tenderness 4.
Diagnosis of Schmorl's Nodes
- The imaging modality of choice for the diagnosis of a Schmorl's node is MRI, as it has a greater capability to detect edema, neovascularization, and extruded disc material 2.
- MRI can also show hyperintensity on T2-weighted images in the regions around the Schmorl's nodes, indicating inflammation and edema 4, 5.
Treatment of Schmorl's Nodes
- The mainstay of treatment for Schmorl's nodes is conservative therapy, which includes rest, physical therapy, and pain management 2, 4.
- In cases where conservative therapy fails, percutaneous vertebroplasty (PVP) or percutaneous balloon kyphoplasty (PKP) may be effective in relieving symptoms 4, 5, 6.
- Surgical removal of disc material may also be necessary in some cases, particularly where there is compression of a nerve root 2.
- Transforaminal epidural block can also be considered as a first treatment option for radicular pain caused by Schmorl's node 3.