Schmorl's Nodes of the Lumbar Spine: Are They Simply Normal

Abstract Background In 1927, Schmorl described a focal herniation of disc material into the adjacent vertebral body through a defect in the endplate, named as Schmorl’s node (SN). The aim of the study is to reveal the prevalence and distribution of Schmorl’s nodes (SNs) in the lumbar spine and their relation to disc degeneration disease in Kirkuk city population. Results A cross-sectional analytic study was done for 324 adults (206 females and 118 males) with lower back pain evaluated as physician requests by lumbosacral MRI at the Azadi Teaching Hospital, Kirkuk city, Iraq. The demographic criteria of the study sample were 20–71 years old, 56–120 kg weight, and 150–181 cm height. SNs were seen in 72 patients (22%). Males were affected significantly more than the females (28.8% vs. 18.8%, P = 0.03). SNs were most significantly affecting older age groups. L1–L2 was the most affected disc level (23.6%) and the least was L5–S1 (8.3%). There was neither a significant relationship between SN and different disc degeneration scores (P = 0.76) nor with disc herniation (P = 0.62, OR = 1.4), but there was a significant relation (P = 0.00001, OR = 7.9) with MC. Conclusion SN is a frequent finding in adults’ lumbar spine MRI, especially in males; it is related to vertebral endplate bony pathology rather than discal pathology.

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Changes in Vertebral Strain Energy Correlate With Increased Presence of Schmorl's Nodes in Multi-Level Lumbar Disk Degeneration

Journal of Biomechanical Engineering ◽

10.1115/1.4027301 ◽

2014 ◽

Vol 136 (6) ◽

Cited By ~ 4

Author(s):

Gregory A. Von Forell ◽

Todd G. Nelson ◽

Dino Samartzis ◽

Anton E. Bowden

Keyword(s):

Lumbar Spine ◽

Strain Energy ◽

Element Model ◽

Nonlinear Finite Element ◽

Disk Degeneration ◽

Physiological Loading ◽

Lumbar Disk Degeneration ◽

Schmorl’S Nodes ◽

Multi Level ◽

Nonlinear Finite Element Model

Patients with skipped-level disk degeneration (SLDD) were recently reported as having a higher prevalence of Schmorl's nodes than patients with contiguous multi-level disk degeneration (CMDD). Fourteen versions of a nonlinear finite element model of a lumbar spine, representing different patterns of single and multi-level disk degeneration, were simulated under physiological loading. Results show that vertebral strain energy is a possible predictor in the development of Schmorl's nodes. The analysis also shows evidence that the development of Schmorl's nodes may be highly dependent on the location of the degeneration disk, with a higher prevalence at superior levels of the lumbar spine.

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Distribution of Schmorl's Nodes in the Lumbar Spine and their Relationship with Lumbar Disc Degeneration and Range of Motion

The Spine Journal ◽

10.1016/j.spinee.2014.08.272 ◽

2014 ◽

Vol 14 (11) ◽

pp. S108

Author(s):

Ruofeng Yin ◽

Jeffrey C. Wang ◽

Elizabeth L. Lord ◽

Jeremiah R. Cohen ◽

Shinji Takahashi

Keyword(s):

Lumbar Spine ◽

Range Of Motion ◽

Disc Degeneration ◽

Lumbar Disc ◽

Lumbar Disc Degeneration ◽

Schmorl’S Nodes

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Is the Morphology and Size of Schmorl's Nodes of the Lumbar Spine Related to Severity of Disk Degeneration?

Global Spine Journal ◽

10.1055/s-0032-1319934 ◽

2012 ◽

Vol 2 (1_suppl) ◽

pp. s-0032-1319934-s-0032-1319934

Author(s):

D. Samartzis ◽

F. Mok ◽

J. Karppinen ◽

K. Luk ◽

K. Cheung

Keyword(s):

Lumbar Spine ◽

Disk Degeneration ◽

Schmorl’S Nodes

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Epidemiology of Lumbar Degenerative Phenotypes of Children and Adolescents: A Large-Scale Imaging Study

Global Spine Journal ◽

10.1177/21925682211000707 ◽

2021 ◽

pp. 219256822110007

Author(s):

Zhong-Yuan Wan ◽

Jun Zhang ◽

Hua Shan ◽

Tang-Fen Liu ◽

Fang Song ◽

...

Keyword(s):

Lumbar Spine ◽

Children And Adolescents ◽

High Intensity ◽

Large Scale ◽

Lumbar Disc ◽

Modic Changes ◽

Lumbar Disc Degeneration ◽

True Incidence ◽

Significant Difference ◽

Schmorl’S Nodes

Study Design: Cross-sectional study. Objective: Recently, there has been a rise in children and adolescents developing low back pain and/or sciatica. Degenerative lumbar spine MRI phenotypes can occur in this population but reports have been sporadic and the true incidence of such spine changes remains debatable. As such, the study aimed to address the epidemiology of MRI phenotypes of the lumbar spine in this young population. Methods: 597 children and adolescents with lumbar MRIs were included in the study. T1- and T2-weighted lumbar images from L1/2 to L5/S1 were analyzed in axial and sagittal planes. Global phenotype assessment was performed of each level and based on established nomenclature protocols. Results: The cohort consisted of 57.3% (342) boys and 42.7% (255) girls, with a mean age of 10.75 ± 5.25 years (range: 0 to 18 years). The prevalence of imaging findings of lumbar disc degeneration (LDD) and lumbar disc herniation (LDH) were 2.2% (95% CI: 0.93–3.43) and 5.8% (95%CI: 2.58-8.99), respectively. There was significant difference between each disc segment from L1/2 to L5/S1 for both LDD and LDH. Schmorl’s nodes were noted in 16 cases (2.7%, youngest case as 15 years), with 11 boys (68.8%) and most frequent segment as L3/4. Modic changes and high-intensity zones were absent in this cohort. Conclusions: LDD can emerge as early as the first decade of life with Schmorl’s nodes, without additional specific phenotypes, including Modic changes and high-intensity zones. The study provides valuable information of a unique age group that is often under-represented but equally important as adults.

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Does the correlation between schmorl's nodes and vertebral morphology extend into the lumbar spine?

American Journal of Physical Anthropology ◽

10.1002/ajpa.22730 ◽

2015 ◽

Vol 157 (3) ◽

pp. 526-534 ◽

Cited By ~ 13

Author(s):

Kimberly Plomp ◽

Charlotte Roberts ◽

Una Strand Vidarsdottir

Keyword(s):

Lumbar Spine ◽

Schmorl’S Nodes

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Impairment Tutorial: Recurrent Radioculpathy: Recurrent Radioculpathy and Apportionment

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2002.julaug03 ◽

2002 ◽

Vol 7 (4) ◽

pp. 8-10

Author(s):

Christopher R. Brigham ◽

Leon H. Ensalada

Keyword(s):

Lumbar Spine ◽

Range Of Motion ◽

Disk Herniation ◽

Fourth Edition ◽

Recurrent Injury ◽

Injury Model ◽

Whole Person ◽

Spinal Region

Abstract Recurrent radiculopathy is evaluated by a different approach in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, compared to that in the Fourth Edition. The AMA Guides, Fifth Edition, specifies several occasions on which the range-of-motion (ROM), not the Diagnosis-related estimates (DRE) method, is used to rate spinal impairments. For example, the AMA Guides, Fifth Edition, clarifies that ROM is used only for radiculopathy caused by a recurrent injury, including when there is new (recurrent) disk herniation or a recurrent injury in the same spinal region. In the AMA Guides, Fourth Edition, radiculopathy was rated using the Injury Model, which is termed the DRE method in the Fifth Edition. Also, in the Fourth Edition, for the lumbar spine all radiculopathies resulted in the same impairment (10% whole person permanent impairment), based on that edition's philosophy that radiculopathy is not quantifiable and, once present, is permanent. A rating of recurrent radiculopathy suggests the presence of a previous impairment rating and may require apportionment, which is the process of allocating causation among two or more factors that caused or significantly contributed to an injury and resulting impairment. A case example shows the divergent results following evaluation using the Injury Model (Fourth Edition) and the ROM Method (Fifth Edition) and concludes that revisions to the latter for rating permanent impairments of the spine often will lead to different results compared to using the Fourth Edition.

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