From the Guidelines
Management of Schmorl's nodes typically focuses on symptom relief as these vertebral disc herniations are often asymptomatic and require no specific treatment. For patients experiencing pain, conservative management is recommended, starting with over-the-counter pain medications like acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) or NSAIDs such as ibuprofen (400-800mg three times daily with food) for 1-2 weeks, as suggested by the American College of Physicians and the American Pain Society 1.
Key Points for Management:
- Physical therapy focusing on core strengthening exercises and proper posture should be implemented for 6-8 weeks, with 2-3 sessions weekly.
- Activity modification to avoid heavy lifting and high-impact activities is advised during the acute pain phase.
- For persistent pain, muscle relaxants like cyclobenzaprine (5-10mg three times daily for 1-2 weeks) may be prescribed, while heat therapy (20 minutes several times daily) can provide additional relief. Most Schmorl's nodes are incidental findings that don't require intervention, as they represent benign endplate herniations of disc material into vertebral bodies. They typically don't progress and rarely cause significant clinical issues, which is why symptomatic treatment is the mainstay of management rather than attempting to address the structural finding itself. It's also important to consider the patient's overall condition and the presence of any underlying serious conditions that may require a different approach, as outlined in guidelines from reputable sources 1.
From the Research
Management of Schmorl's Nodes
The management of Schmorl's nodes, which are herniations of nucleus pulposus through the cartilaginous and bony endplate into the adjacent vertebra, can be summarized as follows:
- Conservative therapy is the mainstay of treatment for both asymptomatic and symptomatic cases 2, 3.
- Surgical removal of disc material has been successful in cases of persistent radiculopathy from compression by a tunneling Schmorl's node 2.
- Medical management options for symptomatic Schmorl's nodes vary, ranging from medical management to surgical fusion 3.
- The use of nonsteroidal anti-inflammatory drugs (NSAIDs) may be considered for alleviating inflammatory symptoms, although their efficacy and potential effects on muscle growth and development should be taken into account 4, 5.
- Topical NSAIDs may be considered as comparable alternatives to oral NSAIDs, with fewer serious adverse events, specifically gastrointestinal reactions 5.
Diagnostic Considerations
- 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 help identify surrounding cortical edema and enhancement, which can suggest an acute Schmorl's node 2.