| Schmorl's nodes | |
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| Classification and external resources | |
X-ray image of Schmorl's nodes in the lumbar spine |
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| ICD-10 | M51.4 |
| ICD-9 | 722.30 |
| DiseasesDB | 32386 |
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.[1]
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These are protrusions of disc material into the surface of the vertebral body, which may contact the marrow 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.
Schmorl's nodes can be detected with x-ray, although they can be imaged better by CT 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.
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.
Schmorl's nodes are named for German pathologist Christian Georg Schmorl (1861–1932).[2]
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