From the Guidelines
Schmorl's nodes are associated with mechanical loading and impact stress on the lower spine, particularly in individuals who engage in activities such as horse riding, chariotry, or wagon/cart driving, as evidenced by a recent study published in Science Advances in 2024 1. The development of Schmorl's nodes is linked to the repetitive stress and loading on the spine, which can lead to degenerative changes, particularly in the lumbar vertebrae.
- The study found that horse riding, chariotry, and wagon/cart driving can all lead to Schmorl's nodes and degenerative changes in the spine due to mechanical loading and impact stress on the lower spine.
- The exact mechanism of Schmorl's node formation is not fully understood, but it is thought to be related to weaknesses in the vertebral endplates, which can be caused by developmental factors, trauma, or degenerative changes.
- The pressure from the nucleus pulposus of the intervertebral disc forces disc material through these weak points into the cancellous bone of the vertebral body, resulting in the formation of Schmorl's nodes.
- While Schmorl's nodes are often asymptomatic, they can sometimes be associated with back pain, particularly when they first develop, as noted in the study published in Science Advances in 2024 1.
- Treatment for painful Schmorl's nodes typically focuses on managing symptoms with conservative measures, including rest, physical therapy, anti-inflammatory medications, and occasionally muscle relaxants.
From the Research
Definition and Pathophysiology of Schmorl's Node
- A Schmorl's node is the herniation of nucleus pulposus through the cartilaginous and bony end plate into the body of the adjacent vertebra 2.
- The pathogenesis of Schmorl's nodes is not fully understood, but an axial load model appears to have the greatest supporting evidence 2.
- Symptomatic Schmorl's nodes are thought to be due to the inflammatory response solicited by the herniation of nucleus pulposus into the well-vascularized vertebral body 2.
Clinical Presentation and Diagnosis
- Schmorl's nodes are common findings on imaging, and although most are asymptomatic, some can become painful lesions 2.
- Symptomatic Schmorl's nodes can cause back pain, and the modality of choice for diagnosis is MRI 3.
- The clinical presentation of Schmorl's nodes can range from simple endplate intravertebral herniation to large cystic lesions of the vertebral body 4.
Treatment Options
- Management options for symptomatic Schmorl's nodes vary, ranging from medical management to surgical fusion 2.
- Conservative approach is recommended when symptoms can be medically well controlled, and spontaneous resolution of symptoms and bone healing can occur within a few months 3.
- Percutaneous vertebroplasty (PVP) is a feasible procedure for patients with painful Schmorl's nodes, with satisfying pain decrease in the following year after procedure 5.