What Are Schmorl's Nodes?
Schmorl's nodes are herniations where the soft, jelly-like center of a spinal disc pushes through a weak spot in the bony endplate (the top or bottom surface of a vertebra) and into the vertebral body itself. 1
Think of it like this: Your spine is made up of stacked bones (vertebrae) with cushions (discs) between them. Each vertebra has a hard top and bottom surface. A Schmorl's node occurs when the soft disc material breaks through this hard surface and pushes into the bone above or below it—similar to how your thumb might push through a weak spot in a cardboard box. 1
How Common Are They?
- Schmorl's nodes are extremely common—over 70% of people have them based on autopsy studies. 1
- They are most frequently found in the lower back (lumbar spine), particularly in people whose activities involve repetitive heavy lifting or spinal loading, such as horseback riding or carrying heavy objects. 2, 3
- Most people with Schmorl's nodes never know they have them because they typically cause no symptoms and are discovered incidentally on X-rays, CT scans, or MRIs done for other reasons. 1
Do They Cause Symptoms?
- The vast majority of Schmorl's nodes are completely asymptomatic and require no treatment. 1
- Rarely, they can cause acute back pain, and even more rarely, they can cause nerve pain (radiculopathy) if they extend backward and compress a nerve root. 1
- When they do cause pain, it's usually self-limited and resolves on its own. 4
How Are They Treated?
Conservative (non-surgical) therapy is the mainstay of treatment for both asymptomatic and symptomatic Schmorl's nodes. 1
For Symptomatic Cases:
- Most patients improve with conservative management including rest, pain medications, and physical therapy. 1
- For persistent, disabling pain not responsive to conservative treatment, minimally invasive options exist:
- Percutaneous vertebroplasty (injecting bone cement into the affected vertebra) has shown swift and persistent pain relief in patients with painful Schmorl's nodes refractory to medical therapy. 5
- In rare cases with persistent nerve compression, surgical decompression or spinal fusion may be considered. 1, 6
Important Diagnostic Considerations:
- MRI is the imaging modality of choice because it can detect bone swelling (edema), new blood vessel formation, and any disc material that has herniated through the bone. 1
- New or acute Schmorl's nodes can be confused with bone metastases (cancer spread) on PET/CT scans in patients with known cancer, so it's crucial to use MRI characteristics and low-dose CT to differentiate them. 2
- Recent Schmorl's nodes with surrounding bone reaction can show uptake on PET scans that mimics malignancy, but their characteristic appearance on MRI and CT helps distinguish them from cancer. 2
Key Takeaway
Schmorl's nodes are common, usually harmless findings where disc material pushes into the vertebral bone. Most people have them without knowing it, and they rarely cause problems. When they do cause pain, it typically resolves with conservative treatment, though minimally invasive procedures are available for persistent cases.