Acute Schmorl's Node during Strenuous Monofin Swimming: A Case Report and Review of the Literature

Abstract

Study Design This case report describes an acute Schmorl's node (SN) in an elite monofin athlete during exercise. The patient presented with severe back pain and leg numbness and was managed successfully with conservative treatment. Objective The aim of our communication was to describe a rare presentation of a common pathological condition during an intense sport. Background Swimming is not generally considered to be a sport activity that leads to spinal injuries. SNs are usually asymptomatic lesions, incidentally found on imaging studies. There is no correlation between swimming and symptomatic SN formation. Case Report A 16-year-old monofin elite athlete suffered from an acute nonradiating back pain during extreme exercise. His back pain was associated with a fracture of the superior L5 end plate and an acute SN at the L5 vertebral body with perilesional bone marrow edema. The pain resolved with nonsteroidal anti-inflammatory drugs and bed rest. The athlete had an excellent outcome and returned to his training activities 6 months after his incident. Conclusion SN should be considered in the differential diagnosis of severe back pain, especially in sport-related injuries. SNs present with characteristic imaging findings. Due to the benign nature of these lesions, surveillance-only management may be the best course of action.

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“…Clinically, they are usually believed to be asymptomatic incidental findings on plain radiographs, computed tomography (CT), and MRI and do not require surgical treatment. However, in some cases, they may denote a severe symptomatic process and cause acute low back pain [ 19 ].…”

“…The histological origins of pain are not yet fully established. It has been postulated that in affected vertebrae there are higher proportions of disc marrow contacts and that the herniating materials irritate a special intravertebral nociceptive system, ultimately generating pain [ 19 , 20 ]. Fields et al [ 20 ] reported a higher nerve density was found in endplate defects than in normal endplates.…”

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“…A reasonable comparison could be made with what is done in the field of monofin research. The average size of the samples of the 5 most recent papers available on PubMed on monofin swimming (search performed on PubMed using "monofin" as keyword, last consulted December 2, 2016) was of 7.6 ± ± 5.4 [8][9][10][11][12]. Therefore, the sample size of the present study was considered as an acceptable target.…”

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