A Retrospective Study of Percutaneous Balloon Kyphoplasty for the Treatment of Symptomatic Schmorl’s Nodes: 5-Year Results

Abstract

BackgroundDespite literature supporting the efficiency of percutaneous balloon kyphoplasty (PKP) in treating osteoporotic and malignant vertebral compression fractures, few reports exist that document its use for treatment of symptomatic Schmorl’s nodes (SNs) refractory to conservative treatment. Patients with symptomatic SNs could have pain in the vertebrae similar to an acute vertebral compression fracture. MRI is very helpful in diagnosing symptomatic SNs when x-ray and CT scan are unremarkable. In painful cases, the vertebrae bone marrow around the SNs is hyperintense on T2-weighted subsequence. We evaluated the long-term safety and effectiveness of PKP for the treatment of symptomatic SNs not responding to conservative therapy.Material/MethodsFrom January 2008 to December 2012, 32 patients suffering from symptomatic SNs underwent 43 PKP procedures. Outcome data, including mean height ratio of anterior and middle vertebral body, Visual Analog Scale (VAS score) for pain measurement, Oswestry Disability Indexes (ODI score) and SF-36 questionnaires for function measurement were recorded preoperatively, postoperatively, and at one month, six months, two years, and five years after treatment.ResultThirty-two patients were treated successfully with PKP. Clinically asymptomatic cement leakage was observed in three (6.98%) of the treated vertebral bodies. The mean height ratio of anterior and middle vertebral bodies changed from 98.2±1.6% preoperatively to 98.5±1.4% postoperatively (p>0.05) and 98.3±1.5% preoperatively to 98.8±1.9% postoperatively (p>0.05). The mean VAS scores, ODI score, and SF-36 scores for physical function (PF), bodily pain (BF), social functioning (SF), and vitality (VT) all showed significant improvements (p<0.05). During the 5-year follow-up, the stabilization of the height of the vertebral body and functional improvements were all maintained.ConclusionsPKP is a safe and effective procedure for the treatment of symptomatic SNs refractory to conservative therapy.

Percutaneous vertebroplasty (PVP) to treat specialized type of endplate fractures around the Schmorl’s node: a prospective study of 65 patients

“…According to previous studies, SNs could cause severe back pain through the release of inflammatory mediators or cause adjacent endplate fractures [7,12]. Although the precise relationship between SNs and back pain remain unclear, a specific subgroup of patients with SNs whose spinal MRI showed a high signal intensity on fat-suppression sequences in the vertebral endplate surrounding the SNs, appear to have severe low back pain that originated from the edematous vertebral endplate [18][19][20][21][22][23][24]. The same signal changes in MRI images were defined as inclusion criteria in our study.…”

“…Because for patients with severe osteoporosis, they do not need a clear traumatic history to develop VCFs, and slight impacts to the spine such as coughing and lifting heavy stuff could lead to bone fractures and result in severe back pain. Based on previous studies, patients with painful SNs who are refractory to conservative treatment show improvement through several surgical procedures including discoblock, percutaneous vertebroplasty, spinal fusion, and tumor necrosis factor alpha (TNF-a) inhibition [18][19][20][21][22][23][24][25][26]. The use of these surgical options is based on the causative factors of low back pain, generated from endplate fractures or from degenerative disc materials that result in a special type of discogenic back pain.…”

“…Vertebral compression fractures are common in the elderly population [16,17], and PVP could obtain satisfactory clinical results. To date, the outcomes of painful SNs with endplate fractures treated by PVP are less well studied and limited to retrospective studies of small sample sizes [18][19][20][21][22][23][24]. We therefore prospectively analyzed 65 cases of endplate fractures around the SNs who underwent PVP in our institution.…”

Percutaneous vertebroplasty (PVP) to treat specialized type of endplate fractures around the Schmorl's node: a prospective study of 65 patients

“…Some studies suggested to insert the working cannulas directed towards the apex of the SNs to fill the polymethylmethacrylate (PMMA) around the profile of the SNs in an eggshell shape [18,21]. However, studies highlighting these procedures are limited to retrospective studies study [18][19][20][21][22][23][24]. Hence, In our study, we treated 65 patients with severe back pain by PVP that were suspected to be secondary to fresh endplate fractures (with high signal intensity on fat-suppression sequences in spinal MRI) around SNs.…”

“…Vertebral compression fractures are common in the elderly population [16,17], and PVP could obtained satisfactory clinical results. To-date, the outcomes of painful SNs with endplate fractures treated by PVP are less well studied and limited to retrospective studies of small sample sizes [18][19][20][21][22][23][24].…”