Schmorl's nodes
Encyclopedia
Schmorl's nodes or Schmorl's nodules are protrusions of the cartilage of the intervertebral disc
through the vertebral body endplate and into the adjacent vertebra.
of the vertebra and lead to inflammation
. The protrusions are also associated with necrosis
of the vertebral bone and the question of whether these protrusions and inflammation cause the necrosis, or whether the cartilage migrates into areas that have become necrotic due to other conditions, is under investigation.
They may or may not be symptomatic, and their etiological significance for back pain
is controversial.
Schmorl's is a significant deformation, and can be found in patients with lifelong history of back problems. Schmorl's can occur at multiple vertebrae, and have been found in patients with chronic pain, radiculopathy, arthritis, arachnoiditis, scoliosis, stenosis, sports or other injury, or disability.
or MRI.
Schmorl's Nodes are considered to be vertical disc herniations through the cartilaginous vertebral body endplates. They can sometimes be seen radiographically, however they are more often seen on MRI, even when not visible on plain film x-ray. They may or may not be symptomatic, and their etiological significance for back pain is controversial.
In a recent study in Spine by Hamanishi, et al.,1 Schmorl's nodes were observed on MRI in 19% of 400 patients with back pain, and in only 9% of an asymptomatic control group.. The authors concluded that Schmorl's nodes are areas of "vertical disc herniation" through areas of weakness in the endplate.
While often non-complicating, Schmorl's nodes also tend to occur more often in cases of spinal deformity, specifically Scheuermann's disease
.
Intervertebral disc
Intervertebral discs lie between adjacent vertebrae in the spine. Each disc forms a cartilaginous joint to allow slight movement of the vertebrae, and acts as a ligament to hold the vertebrae together.-Structure:...
through the vertebral body endplate and into the adjacent vertebra.
Presentation
These are protrusions of disc material into the surface of the vertebral body, which may contact the marrowBone marrow
Bone marrow is the flexible tissue found in the interior of bones. In humans, bone marrow in large bones produces new blood cells. On average, bone marrow constitutes 4% of the total body mass of humans; in adults weighing 65 kg , bone marrow accounts for approximately 2.6 kg...
of the vertebra and lead to inflammation
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...
. The protrusions are also associated with necrosis
Necrosis
Necrosis is the premature death of cells in living tissue. Necrosis is caused by factors external to the cell or tissue, such as infection, toxins, or trauma. This is in contrast to apoptosis, which is a naturally occurring cause of cellular death...
of the vertebral bone and the question of whether these protrusions and inflammation cause the necrosis, or whether the cartilage migrates into areas that have become necrotic due to other conditions, is under investigation.
They may or may not be symptomatic, and their etiological significance for back pain
Back pain
Back pain is pain felt in the back that usually originates from the muscles, nerves, bones, joints or other structures in the spine.The pain can often be divided into neck pain, upper back pain, lower back pain or tailbone pain...
is controversial.
Schmorl's is a significant deformation, and can be found in patients with lifelong history of back problems. Schmorl's can occur at multiple vertebrae, and have been found in patients with chronic pain, radiculopathy, arthritis, arachnoiditis, scoliosis, stenosis, sports or other injury, or disability.
Diagnosis
Schmorl's nodes can be detected with x-ray, although they can be imaged better by CTComputed tomography
X-ray computed tomography or Computer tomography , is a medical imaging method employing tomography created by computer processing...
or MRI.
Schmorl's Nodes are considered to be vertical disc herniations through the cartilaginous vertebral body endplates. They can sometimes be seen radiographically, however they are more often seen on MRI, even when not visible on plain film x-ray. They may or may not be symptomatic, and their etiological significance for back pain is controversial.
In a recent study in Spine by Hamanishi, et al.,1 Schmorl's nodes were observed on MRI in 19% of 400 patients with back pain, and in only 9% of an asymptomatic control group.. The authors concluded that Schmorl's nodes are areas of "vertical disc herniation" through areas of weakness in the endplate.
Causes
Schmorl's nodes are fairly common, especially with minor degeneration of the aging spine, but they are also seen in younger spines. Schmorl's nodes often cause no symptoms, but may simply reflect that "wear and tear" of the spine has occurred over time; they may also reflect that bone strength was at one time somewhat compromised, perhaps due to a vitamin D deficiency, although this has yet to be confirmed with studies.While often non-complicating, Schmorl's nodes also tend to occur more often in cases of spinal deformity, specifically Scheuermann's disease
Scheuermann's disease
Scheuermann’s disease is a self-limiting skeletal disorder of childhood. It is also known as Sherman's Disease, Scheuermann’s kyphosis , Calvé disease and Juvenile Osteochondrosis of the Spine. It is named after Holger Werfel Scheuermann...
.