Differentiation between spinal subchondral bone metastasis with focal pathologic endplate fracture and oedematous Schmorl’s node

Abstract Background The Schmorl’s nodes (SNs) are defined as the herniation of the intervertebral disc into the vertebral body. Endplate fractures around the Schmorl’s node could result in severe back pain that is similar to vertebral compression fractures. The objective of this study was to prospectively analyze the surgical effectiveness and safety of percutaneous vertebroplasty (PVP) for endplate fractures around the SNs. Methods Seventy-one consecutive patients with the fresh endplate fracture around SNs from October 2017 to February 2018 were enrolled in this study. The visual analog scale (VAS) and Oswestry disability index (ODI) scores of low back pain were evaluated in all patients preoperatively, postoperatively, and at 1 month, 6 months, and 1 year after primary single level PVP. Surgery-related data including duration of the operation, injected cement volumes, and surgical complications were recorded. Results Sixty-five patients with fresh endplate fractures around the SNs were treated successfully via percutaneous vertebroplasty. Our study showed that the VAS scores and ODI scores of patients were obviously improved after operation. Cement leakage into the disc space occurred in 5 patients (7.7%), and adjacent segment refractures occurred in 2 patients (3.1%). No other surgical complications, including infections or nerve root injuries were encountered. Conclusions Based on the results of this prospective study, PVP was an effective and safe procedure for endplate fractures around the SNs. Trial registration ChiCTR, ChiCTR1800016453. Registered 2 June 2018—retrospectively registered, http://www.chictr.org.cn/com/25/historyversionpuben.aspx?regno=ChiCTR1800017602

Download Full-text

Infected Schmorl’s node: a case report

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03276-4 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Hyeun Sung Kim ◽

Harshavardhan Dilip Raorane ◽

Sagar Bhupendra Sharma ◽

Pang Hung Wu ◽

Il-Tae Jang

Keyword(s):

Case Report ◽

Schmorl's Node ◽

Schmorl’S Node

Download Full-text

Evolution of a Schmorl’s Node and a Degenerative Osteophyte on Sequential 68Ga-DOTATATE PET/CT Scans

Clinical Nuclear Medicine ◽

10.1097/rlu.0000000000002353 ◽

2019 ◽

Vol 44 (1) ◽

pp. e40-e42

Author(s):

Nir Hod ◽

Daniel Levin ◽

Reut Anconina ◽

Elya Benkovich ◽

Dina Ezroh Kazap ◽

...

Keyword(s):

Ct Scans ◽

Pet Ct ◽

Schmorl's Node ◽

Schmorl’S Node

Download Full-text

Painful Schmorl's Node: Another Cause of Vertebral Photopenia on Indium-111-Labeled Leukocyte Scintigraphy

Clinical Nuclear Medicine ◽

10.1097/00003072-199903000-00023 ◽

1999 ◽

Vol 24 (3) ◽

pp. 206-208 ◽

Cited By ~ 1

Author(s):

IAN D. KIRKWOOD ◽

DOUGLAS I. QUINT ◽

ANDREW HAIG ◽

RICHARD L. WAHL

Keyword(s):

Leukocyte Scintigraphy ◽

Indium 111 ◽

Schmorl's Node ◽

Schmorl’S Node

Download Full-text

Surgical management of a Schmorl's node in an Airedale Terrier and review of the literature

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-11-06-0088 ◽

2012 ◽

Vol 25 (02) ◽

pp. 167-171 ◽

Cited By ~ 2

Author(s):

L. Hillebrand ◽

T. J. Smith ◽

S. M. Stieger-Vanegas ◽

W. I. Baltzer

Keyword(s):

Surgical Management ◽

Lumbar Vertebra ◽

Spinal Pain ◽

Review Of The Literature ◽

Disc Space ◽

Term Outcome ◽

Hindlimb Muscle ◽

Dorsal Laminectomy ◽

Schmorl's Node ◽

Schmorl’S Node

SummaryObjective: To describe a clinical case of Schmorl's node affecting the lumbosacral disc in an Airedale Terrier including surgical management, short-term outcome, and review of the literature.Methods: A five-year-old male Airedale Terrier with signs of chronic spinal pain and right hindlimb muscle fasciculation was diagnosed with a Schmorl's node with computed tomography. Repeat imaging performed two months later identified enlargement of the defect in the seventh lumbar vertebra (L7) and herniation of the lumbosacral disc into the spinal canal.Results: Dorsal laminectomy and discectomy were performed and the defect was treated with curettage and stabilization of the L7 and first sacral vertebra disc space with pins and bone cement. Immediately postoperatively, the patient had proprioception deficits in the hindlimbs and decreased right patellar reflex. Over the next four months the dog's neurological condition improved and no neurological or gait deficits were present six months postoperatively.Clinical significance: Schmorl's node may be a cause of signs of chronic pain in dogs. Successful management may be achieved surgically, although in the case reported here, recovery was prolonged. To the authors' knowledge, this is the first report of progressive enlargement of a Schmorl's node in a dog.

Download Full-text

Biomechanical Comparison of Vertebral Augmentation and Cement Discoplasty for the Treatment of Symptomatic Schmorl’s Node Combined With Modic Change: Finite Element Analyses

10.21203/rs.3.rs-266943/v1 ◽

2021 ◽

Author(s):

Kaiwen Cai ◽

Kefeng Luo ◽

Feng Cao ◽

Bin Lu ◽

Yuanhua Wu ◽

...

Keyword(s):

Finite Element ◽

Strain Differences ◽

Vertebral Augmentation ◽

Modic Change ◽

Ideal Model ◽

Stress Peak ◽

Adjacent Vertebral Fracture ◽

Ct Data ◽

Schmorl's Node ◽

Schmorl’S Node

Abstract Study design: Finite element simulation study.Objective: To compare the biomechanical effects of percutaneous vertebral augmentation (PVA) and percutaneous cement discoplasty (PCD) in patients with symptomatic Schmorl’s node combined with Modic change.Methods: CT data from a single patient was assembled into finite element models, from which we constructed four distinct surgical models, including PVA-ideal, PVA-nonideal, PCD-ideal, and PCD-nonideal, to compare the stress and strain differences of parapodular tissues.Results: The validity of our model was confirmed. PVA-ideal model showed a moderate reduction in the stress peak of the Schmorl’s node (0.48 vs. 0.81–0.89 Mpa) in the erect position. In the PCD-ideal model, the stress peak of the Schmorl’s node increased significantly when the spine was moved toward the lesion (3.99Mpa). Both PVA-ideal and PCD-ideal models showed global strain inhibition at the Schmorl’s node and BMEZ, which was attenuated in the non-ideal models. The PCD-ideal model significantly reduced segmental ROM (-76.8% to -59.3%) and significantly increases endplate stress (up to 220.8%), with no such effects seen in the PVA-ideal model.Conclusions: Both PVA-ideal and PCD-ideal models facilitated a more stable parapodular biomechanical microenvironment. The PVA-ideal model yielded minimal stress disturbance on the augmented or adjacent vertebral endplate but offered no improvement to segment stability. The PCD-ideal model provides adequate segment stability, but also carries a greater risk for adjacent vertebral fracture. As nonideal implementations of both surgeries can result in poor biomechanical outcomes, the surgical indications of PVA or PCD need to be carefully selected.

Download Full-text