Symptomatic intraosseous Schmörl herniation
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Published:
Aug 5, 2019
Keywords:
Symptomatic, intraosseous, hernia, Schmörl.
Main Article Content
Abstract
Intraosseous disc herniation –or Schmörl nodes (SN)– are a herniation or prolapse of the nucleus pulposus of the intervertebral disc through the vertebral plate and into the adjacent vertebral body. They are usually associated with vertebral deformities, such as Scheuermann’s disease, or rheumatic diseases, such as ankylopoietic spondylitis. In general, they are spontaneous and asymptomatic findings, and there are only a few reported cases of symptomatic nodes. The etiology is supposedly related to a weakened spinal plate due to trauma or repeated stress. When the node is acute or recent, it can be difficult to differentiate a benign degeneration from a malignant infiltration or infection. In this paper, we discuss the unusual case of a painful Schmörl node in a man with no relevant history and a masked metastatic lumbar spinal tumor originated from pancreatic cancer. We performeda literature review.
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How to Cite
Guimbard Pérez, J. H., Barriga-Martín, A., & Romero-Munóz, L. M. (2019). Symptomatic intraosseous Schmörl herniation. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 84(3), 273-285. https://doi.org/10.15417/issn.1852-7434.2019.84.3.847
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Case Presentations
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References
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2. Pilet B, Salgado R, Van Havenbergh T, Parizel PM. Development of acute Schmorl nodes after discography. J Comput Assist Tomogr 2009;33:597-600. https://doi.org/10.1097/RCT.0b013e318188598b
3. Williams FM, Manek NJ, Sambrook PN, Spector TD, Macgregor AJ. Schmorl’s nodes: common, highly heritable, and related to lumbar disc disease. Arthritis Rheum 2007;57:855-60. https://doi.org/10.1002/art.22789
4. Wu HT, Morrison WB, Schweitzer ME. Edematous Schmorl’s nodes on thoracolumbar MR imaging: characteristic patterns and changes over time. Skeletal Radiol 2006;35:212-9. https://doi.org/10.1007/s00256-005-0068-y
5. Jang JS, Kwon HK, Lee JJ, Hwang SM, Lim SY. Rami communicans nerve block for the treatment of symptomatic Schmorl’s nodes: a case report. Korean J Pain 2010;23:262-5. https://doi.org/10.3344/kjp.2010.23.4.262
6. Fahey V, Opeskin K, Silberstein M, Anderson R, Briggs C. The pathogenesis of Schmorl’s nodes in relation to acute trauma: an autopsy study. Spine (Phila Pa 1976) 1998;23:2272-5. PMID: 9820905
7. Grive E, Rovira A, Capellades J, Rivas A, Pedraza S. Radiologic findings in two cases of acute Schmorl’s nodes. AJNR Am J Neuroradiol 1999;20:1717-21. http://www.ajnr.org/content/ajnr/20/9/1717.full.pdf
8. Crawford BA, van der Wall H. Bone scintigraphy in acute intraosseous disc herniation. Clin Nucl Med 2007;32:790-2. https://doi.org/10.1097/RLU.0b013e318149ee54
9. Resnick D, Niwayama G. Intravertebral disk herniations: cartilaginous (Schmorl’s) nodes. Radiology 1978;126:57-65. https://doi.org/10.1148/126.1.57
10. Hilton RC, Ball J, Benn RT. Vertebral end-plate lesions (Schmorl’s nodes) in the dorsolumbar spine. Ann Rheum Dis 1976;35:127-32. https://doi.org/10.1136/ard.35.2.127
11. Dar G, Masharawi Y, Peleg S, Steinberg N, May H, Medlej B, et al. Schmorl’s nodes distribution in the human spine and its possible etiology. Eur Spine J 2010;19:670-5. https://doi.org/ 10.1007/s00586-009-1238-8
12. Silberstein M, Opeskin K, Fahey V. Spinal Schmorl’s nodes: sagittal sectional imaging and pathological examination. Australas Radiol 1999;43:27-30. https://doi.org/10.1046/j.1440-1673.1999.00613.x
13. Hamanishi C, Kawabata T, Yosii T, Tanaka S. Schmorl’s nodes on magnetic resonance imaging. Their incidence and clinical relevance. Spine (Phila Pa 1976) 1994;19:450-3. PMID: 8178234
14. Stabler A, Bellan M, Weiss M, Gartner C, Brossmann J, Reiser MF. MR imaging of enhancing intraosseous disk herniation (Schmorl’s nodes). AJR Am J Roentgenol 1997;168:933-8. https://doi.org/10.2214/ajr.168.4.9124143
15. Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 1994;331:69-73. https://doi.org/10.1056/NEJM199407143310201
16. Takahashi K, Miyazaki T, Ohnari H, Takino T, Tomita K. Schmorl’s nodes and low-back pain. Analysis of magnetic resonance imaging findings in symptomatic and asymptomatic individuals. Eur Spine J 1995;4:56- 9. https://doi.org/10.1007/bf00298420
17. Walters G, Coumas JM, Akins CM, Ragland RL. Magnetic resonance imaging of acute symptomatic Schmorl’s node formation. Pediatr Emerg Care 1991;7:294-6. https://doi.org/10.1097%2F00006565-199110000-00009
18. Seymour R, Williams LA, Rees JI, Lyons K, Lloyd DC. Magnetic resonance imaging of acute intraosseous disc herniation. Clin Radiol 1998;53:363-8. https://doi.org/10.1016/S0009-9260(98)80010-X
19. Pfirrmann CW, Resnick D. Schmorl nodes of the thoracic and lumbar spine: radiographic-pathologic study of prevalence, characterization, and correlation with degenerative changes of 1,650 spinal levels in 100 cadavers. Radiology 2001;219:368-74. https://doi.org/10.1148/radiology.219.2.r01ma21368
20. Hasegawa K, Ogose A, Morita T, Hirata Y. Painful Schmorl’s node treated by lumbar interbody fusion. Spinal Cord 2004;42:124-8. https://doi.org/10.1038/sj.sc.3101506
21. Masala S, Pipitone V, Tomassini M, Massari F, Romagnoli A, Simonetti G. Percutaneous vertebroplasty in painful schmorl nodes. Cardiovasc Intervent Radiol 2006;29:97-101. https://doi.org/10.1007/s00270-005-0153-6
22. Wenger M, Markwalder TM. Fluoronavigation-assisted, lumbar vertebroplasty for a painful Schmorl node. J Clin Neurosci 2009;16:1250-1251. https://doi.org/10.1016/j.jocn.2008.11.016
23. Yamaguchi T, Suzuki S, Ishiiwa H, Yamato M, Ueda Y. Schmorl’s node developing in the lumbar vertebra affected with metastatic carcinoma: correlation magnetic resonance imaging with histological findings. Spine 2003;28(24):E503-E505. https://doi.org/10.1097/01.BRS.0000099388.63504.4D
24. Borad MJ, Saadati H, Lakshmipathy A, Campbell E, Hopper P, Jameson G, et al. Skeletal metastases in pancreatic cancer: a retrospective study and review of the literature. Yale J Biol Med 2009;82(1):1-6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2660584/
25. Pneumaticos SG, Savidou C, Korres DS, Chatziioannou SN. Pancreatic cancer’s initial presentation: back pain due to osteoblastic bone metastasis. Eur J Cancer Care 2010;19(1):137-40. https://doi.org/10.1111/j.1365-2354.2007.00920.x
2. Pilet B, Salgado R, Van Havenbergh T, Parizel PM. Development of acute Schmorl nodes after discography. J Comput Assist Tomogr 2009;33:597-600. https://doi.org/10.1097/RCT.0b013e318188598b
3. Williams FM, Manek NJ, Sambrook PN, Spector TD, Macgregor AJ. Schmorl’s nodes: common, highly heritable, and related to lumbar disc disease. Arthritis Rheum 2007;57:855-60. https://doi.org/10.1002/art.22789
4. Wu HT, Morrison WB, Schweitzer ME. Edematous Schmorl’s nodes on thoracolumbar MR imaging: characteristic patterns and changes over time. Skeletal Radiol 2006;35:212-9. https://doi.org/10.1007/s00256-005-0068-y
5. Jang JS, Kwon HK, Lee JJ, Hwang SM, Lim SY. Rami communicans nerve block for the treatment of symptomatic Schmorl’s nodes: a case report. Korean J Pain 2010;23:262-5. https://doi.org/10.3344/kjp.2010.23.4.262
6. Fahey V, Opeskin K, Silberstein M, Anderson R, Briggs C. The pathogenesis of Schmorl’s nodes in relation to acute trauma: an autopsy study. Spine (Phila Pa 1976) 1998;23:2272-5. PMID: 9820905
7. Grive E, Rovira A, Capellades J, Rivas A, Pedraza S. Radiologic findings in two cases of acute Schmorl’s nodes. AJNR Am J Neuroradiol 1999;20:1717-21. http://www.ajnr.org/content/ajnr/20/9/1717.full.pdf
8. Crawford BA, van der Wall H. Bone scintigraphy in acute intraosseous disc herniation. Clin Nucl Med 2007;32:790-2. https://doi.org/10.1097/RLU.0b013e318149ee54
9. Resnick D, Niwayama G. Intravertebral disk herniations: cartilaginous (Schmorl’s) nodes. Radiology 1978;126:57-65. https://doi.org/10.1148/126.1.57
10. Hilton RC, Ball J, Benn RT. Vertebral end-plate lesions (Schmorl’s nodes) in the dorsolumbar spine. Ann Rheum Dis 1976;35:127-32. https://doi.org/10.1136/ard.35.2.127
11. Dar G, Masharawi Y, Peleg S, Steinberg N, May H, Medlej B, et al. Schmorl’s nodes distribution in the human spine and its possible etiology. Eur Spine J 2010;19:670-5. https://doi.org/ 10.1007/s00586-009-1238-8
12. Silberstein M, Opeskin K, Fahey V. Spinal Schmorl’s nodes: sagittal sectional imaging and pathological examination. Australas Radiol 1999;43:27-30. https://doi.org/10.1046/j.1440-1673.1999.00613.x
13. Hamanishi C, Kawabata T, Yosii T, Tanaka S. Schmorl’s nodes on magnetic resonance imaging. Their incidence and clinical relevance. Spine (Phila Pa 1976) 1994;19:450-3. PMID: 8178234
14. Stabler A, Bellan M, Weiss M, Gartner C, Brossmann J, Reiser MF. MR imaging of enhancing intraosseous disk herniation (Schmorl’s nodes). AJR Am J Roentgenol 1997;168:933-8. https://doi.org/10.2214/ajr.168.4.9124143
15. Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 1994;331:69-73. https://doi.org/10.1056/NEJM199407143310201
16. Takahashi K, Miyazaki T, Ohnari H, Takino T, Tomita K. Schmorl’s nodes and low-back pain. Analysis of magnetic resonance imaging findings in symptomatic and asymptomatic individuals. Eur Spine J 1995;4:56- 9. https://doi.org/10.1007/bf00298420
17. Walters G, Coumas JM, Akins CM, Ragland RL. Magnetic resonance imaging of acute symptomatic Schmorl’s node formation. Pediatr Emerg Care 1991;7:294-6. https://doi.org/10.1097%2F00006565-199110000-00009
18. Seymour R, Williams LA, Rees JI, Lyons K, Lloyd DC. Magnetic resonance imaging of acute intraosseous disc herniation. Clin Radiol 1998;53:363-8. https://doi.org/10.1016/S0009-9260(98)80010-X
19. Pfirrmann CW, Resnick D. Schmorl nodes of the thoracic and lumbar spine: radiographic-pathologic study of prevalence, characterization, and correlation with degenerative changes of 1,650 spinal levels in 100 cadavers. Radiology 2001;219:368-74. https://doi.org/10.1148/radiology.219.2.r01ma21368
20. Hasegawa K, Ogose A, Morita T, Hirata Y. Painful Schmorl’s node treated by lumbar interbody fusion. Spinal Cord 2004;42:124-8. https://doi.org/10.1038/sj.sc.3101506
21. Masala S, Pipitone V, Tomassini M, Massari F, Romagnoli A, Simonetti G. Percutaneous vertebroplasty in painful schmorl nodes. Cardiovasc Intervent Radiol 2006;29:97-101. https://doi.org/10.1007/s00270-005-0153-6
22. Wenger M, Markwalder TM. Fluoronavigation-assisted, lumbar vertebroplasty for a painful Schmorl node. J Clin Neurosci 2009;16:1250-1251. https://doi.org/10.1016/j.jocn.2008.11.016
23. Yamaguchi T, Suzuki S, Ishiiwa H, Yamato M, Ueda Y. Schmorl’s node developing in the lumbar vertebra affected with metastatic carcinoma: correlation magnetic resonance imaging with histological findings. Spine 2003;28(24):E503-E505. https://doi.org/10.1097/01.BRS.0000099388.63504.4D
24. Borad MJ, Saadati H, Lakshmipathy A, Campbell E, Hopper P, Jameson G, et al. Skeletal metastases in pancreatic cancer: a retrospective study and review of the literature. Yale J Biol Med 2009;82(1):1-6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2660584/
25. Pneumaticos SG, Savidou C, Korres DS, Chatziioannou SN. Pancreatic cancer’s initial presentation: back pain due to osteoblastic bone metastasis. Eur J Cancer Care 2010;19(1):137-40. https://doi.org/10.1111/j.1365-2354.2007.00920.x