Schmorl’s node case presentation
- 1. Schmorl’s node A Case presentation By: Dr Rekha Khare MD Radiology
- 2. Schmorl’s node: • Christian George Schmorl German pathologist named it as Schmorl’s Node in 1927
- 3. Clinical Presentation: • MRI has been done for a young school boy aged 18years. His main complaint was chronic backache all over from neck to down for last few years • On examination there was no remarkable clinical sign There was no any other constitutional symptom. • Routine laboratory examination was within normal limit.
- 4. MRI Cervico-dorsal spine…… • Sagittal T2 sequence:
- 12. MRI Lumbar spine T2 sagittal Planning film:
- 21. MRI Lumbar region…… • Sagittal T1 sequence:
- 27. MRI Lumbar spine L4-5….. • Axial T1 & T2 sequence:
- 30. MRI Lumbar spine…… • Coronal T2 sequence:
- 33. MRI Whole spine……. • Sagittal screening whole spine:
- 36. MRI Lumbar Spine serial sequence • Lumbar curvature seems to be maintained • Vertebrae are with slightly reduced height--flat vertebrae. • Multilevel disc bulging, few are with low signal/ dehydrated more at L2-3,L3-4
- 37. MRI FINDING CONTD……. • T1 and T2 weighted sagittal MR scan of the lumbar spine showing rounded fairly central endplate cortical defects/ schmorls node with herniated disc material at T12,L1,2,5.
- 38. MRI FINDING CONTD……. • No significant high signal due to inflammation & oedma is noted in the bone marrow surrounding the schmorls node in T2 weighted slice • IV Disc spaces are not remarkably reduced
- 39. MRI SCREENING OF SPINE……. • Central schmorls node at lower cervical 5,6,7 and multiple lower thoracic vertebrae. Minimal marginal defect at T1,2,3 • Soft tissue humping in cervical region.
- 40. DISCUSSION: • Vertebral end plate are critical for maintaining disc function yet like other components of the disc endplate are vulnerable to degeneration.
- 41. Discussion contd……. • Schmorls node is Protrusion of the cartilage of the intervertebral disc through vertebral body end plate & into adjacent vertebra. • Protrusion may contact the marrow of the vertebra leading to inflammation
- 42. Discussion contd……. • Etiology is controversial. Schmorls node is fairly common esp with minor degeneration of the aging spine but they could be seen in younger spine often no symptom • May simply reflect Wear & Tear of the spine
- 43. Discussion contd……. • . It is believed that schmorls node develop following back trauma • Nucleus pulposus pressure on the weakest part of endplate
- 44. Discussion contd……. • They may also reflect that bone strength was at one time some what compromised perhaps due to vitamin D deficiency
- 45. Discussion contd……. • . It was yet to confirmed with studies if heavy lifting is done at younger age before the vertebra are completely ossified such as in young farm workers.
- 46. Discussion contd……. • It is among the diagnostic criteria of Scheuermann’s disease • A Limbus vertebra is closely related to schmorls node, detected on x-ray better on CT or MRI
- 47. REFERENCES: 1. Dr Tim Luijks and Dr Behrang Amin etal.: Schmorl node . Radiopaedia.org.com 2. Mc Fadden KD, Taylor JR: End Plate Lesion of Lumbar spine Spine 1989, 14(8):867-869 3. Robert J.Moore: The vertebral end plate: Disc degeneration,disc regeneration. EurSpine J.Aug 2006(suppl.3)333-337 4. Takahashi K, Miyazaki T, Ohnari H, Tonita K: Schmorls nodes and low back pain- Analysis of magnetic resonance of imaging finding in symptomatic and asymptomatic individual, Eur Spine J.1995,4(1)56-9 5. Leo F. Czervionke and Douglous S. Fenton: Imaging painful spine disorder 6. Dr Henry Knipe and Dr Frank Gailard etal. : Scheuermann disease , Radiopaedia.org .Com •