Schmorl’s nodeA Case presentation

By: Dr Rekha Khare

MD Radiology

Schmorl’s node:

• Christian George Schmorl German pathologist named it

as Schmorl’s Node in 1927

Clinical Presentation:

• MRI has been done for a young school boyaged 18years. His main complaint was chronicbackache all over from neck to down for last few years

• On examination there was no remarkable clinicalsign There was no any other constitutionalsymptom.

• Routine laboratory examination was within normallimit.

MRI Cervico-dorsal spine……

• Sagittal T2 sequence:

MRI Lumbar spine T2 sagittal

Planning film:

MRI Lumbar region……

• Sagittal T1 sequence:

MRI Lumbar spine L4-5…..

• Axial T1 & T2 sequence:

MRI Lumbar spine……

• Coronal T2 sequence:

MRI Whole spine…….

• Sagittal screening whole spine:

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

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.

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

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.

DISCUSSION:

• Vertebral end plate are critical for

maintaining disc function yet like other

components of the disc endplate are

vulnerable to degeneration.

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

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

Discussion contd…….

• . It is believed that schmorls node develop

following back trauma

• Nucleus pulposus pressure on the

weakest part of endplate

Discussion contd…….

• They may also reflect that bone strength

was at one time some what compromised

perhaps due to vitamin D deficiency

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.

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

REFERENCES:

1. Dr Tim Luijks and Dr Behrang Amin etal.: Schmorl node .Radiopaedia.org.com2. Mc Fadden KD, Taylor JR: End Plate Lesion of Lumbar spineSpine 1989, 14(8):867-8693. Robert J.Moore: The vertebral end plate: Disc degeneration,discregeneration. EurSpine J.Aug 2006(suppl.3)333-3374. Takahashi K, Miyazaki T, Ohnari H, Tonita K: Schmorls nodesand low back pain- Analysis of magnetic resonance of imagingfinding in symptomatic and asymptomatic individual, Eur SpineJ.1995,4(1)56-95. Leo F. Czervionke and Douglous S. Fenton: Imaging painful spinedisorder6. Dr Henry Knipe and Dr Frank Gailard etal. : Scheuermann

disease , Radiopaedia.org .Com•