Schmorl's Nodes
- 2. SCHMORL’S NODES Ade Wijaya, MD February 2018
- 3. INTRODUCTION First described by the pathologist Christian Georg Schmorl in 1927 Herniation of nucleus pulposus through the cartilaginous and bony endplate into the body of the adjacent vertebra Mattei, T. A., & Rehman, A. A. (2014). Schmorl's nodes: current pathophysiological, diagnostic, and therapeutic paradigms. Neurosurgical review, 37(1), 39-46.
- 4. EPIDEMIOLOGY Male > Female T7-L1 region Middle portion and inferior surface of the vertebral body Size: 1 – 9 mm In asymptomatic patients found in 19 % Dar G, Masharawi Y, Peleg S, Steinberg N, May H, Medlej B, Peled N, Hershkovitz I (2010) Schmorl's nodes distribution in the human spine and its possible etiology. Eur Spine J 19:670–675 Hilton RC, Ball J, Benn RT (1976) Vertebral end-plate lesions (Schmorl‘s nodes) in the dorsolumbar spine. Ann Rheum Dis 35:127–132 Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS (1994) Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 331:69–73 Peng B, Chen J, Kuang Z, Li D, Pang X, Zhang X (2009) Diagnosis and surgical treatment of back pain originating from endplate. EurSpine J 18:1035–1040
- 5. GENETICS Aggrecan gene polymorphism A vitamin D receptor Matrix metalloproteinase-3 gene alleles Jones G, White C, Sambrook P, Eisman J 1998) Allelic variation in the vitamin D receptor, lifestyle factors and lumbar spinal degenerative disease. Ann Rheum Dis 57:94–99 Kawaguchi Y, Osada R, Kanamori M, Ishihara H, Ohmori K, Matsui H, Kimura T (1999) Association between an aggrecan gene polymorphism and lumbar disc degeneration. Spine (Phila Pa 1976) 24:2456–2460Resnick D, Niwayama G (1978) Intervertebral disc herniations: cartilaginous (Schmorl's) nodes. Radiology 126:57–65
- 6. PATHOPHYSIOLOGY Abnormalities of the vertebral blood vessels during development Ischemic necrosis beneath the cartilaginous endplate, and that herniation of the nucleus pulposus into the vertebral body would be a secondary phenomenon Schmorl's nodes have already been correlated with degenerative disc disease, low back pain, and Modic changes Mattei, T. A., & Rehman, A. A. (2014). Schmorl's nodes: current pathophysiological, diagnostic, and therapeutic paradigms. Neurosurgical review, 37(1), 39-46.
- 7. Modic MT, Masaryk TJ, Ross JS, Carter JR (1988) Imaging of degenerative disc disease. Radiology 168:177–186 Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR (1988) Degenerative disc disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 166:193–199
- 8. CLINICAL PRESENTATION Low back pain ( AXIAL & radicular ) Osteoporotic fractures Mattei, T. A., & Rehman, A. A. (2014). Schmorl's nodes: current pathophysiological, diagnostic, and therapeutic paradigms. Neurosurgical review, 37(1), 39-46.
- 9. TREATMENT Most cases asymptomatic A small subgroup of patients with refractory low back pain (and in whom the MRI findings demonstrate a Schmorl's node of significant dimension and adjacent bone edema), may benefit from some form of intervention. Mattei, T. A., & Rehman, A. A. (2014). Schmorl's nodes: current pathophysiological, diagnostic, and therapeutic paradigms. Neurosurgical review, 37(1), 39-46.
- 10. TREATMENT Vertebroplasty Lumbar fusion Other alternative treatments: TNF-α inhibitor (infliximab) Mattei, T. A., & Rehman, A. A. (2014). Schmorl's nodes: current pathophysiological, diagnostic, and therapeutic paradigms. Neurosurgical review, 37(1), 39-46.
- 11. SUMMARY One of the cause of chronic axial pain. In symtomatic patients, MRI showns surrounding edema and contrast enhancement due to hypervascularization. Treatment: vertebroplasty or lumbar fusion.
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