Lumbar spine Schmorl's nodes; prevalence in adults with back pain, and their relation to vertebral endplate degeneration

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.

Evaluation of Cartilaginous Endplate Degeneration Based on Magnetic Resonance Imaging

“…The degeneration of the lumbar cartilaginous endplate has a typical MRI appearance; combined with the clinical history, the diagnosis is not difficult, but it still needs to be differentiated from spinal tuberculosis and purulent inflammation. The more severe the cartilaginous endplate is damaged, the higher the grade of the lumbar intervertebral disc, that is, the shape of the cartilaginous endplate is closely related to the degree of lumbar intervertebral disc degeneration [ 13 ]. As the degree of cartilaginous endplate degeneration intensifies, the lumbar intervertebral disc is in a state of continuous nutrient shortage, which causes the corresponding intervertebral disc cell apoptosis, which intensifies the degree of lumbar intervertebral disc degeneration in patients, and the higher the grade of the intervertebral disc.…”

Multiple Schmorl’s Nodes on Young Adult With Myofascial Pain Syndrome: A Case Report

“…5,6 SN is mostly found in men and increases with age due to weakening of the cartilage endplate and decreased bone density, with a peak in the fourth decade of life. 3,4 Based on the location, a study in the Iraqi population found that SN was most common in the L1-L2 vertebral region, and the least in the L5-S1 vertebral region. 3 In a study in India, SN was found in the thoracic and lumbar regions, where 59.5% had SN at only one intervertebral disc and 40.4% had multiple SN at different vertebral levels.…”

“…3,4 Based on the location, a study in the Iraqi population found that SN was most common in the L1-L2 vertebral region, and the least in the L5-S1 vertebral region. 3 In a study in India, SN was found in the thoracic and lumbar regions, where 59.5% had SN at only one intervertebral disc and 40.4% had multiple SN at different vertebral levels. 4 Another epidemiological analysis revealed that SN occurs frequently in thoracolumbar transition (T7-L1) and commonly affects the inferior surface of the vertebral body.…”

“…2 SN is caused by the weakening of the cartilaginous endplate and subchondral bone due to ischemic necrosis. 3 This condition is commonly associated with pathologic conditions such as metabolic diseases, neoplasms, and trauma. 2 Most cases of SN are asymptomatic and detected on incidental findings.…”

Ablation of Rami Communicans in Patients with Symptomatic Schmorl's Nodes: A Case Report

“…This can be due to factors intrinsic to the endplate (presence of indentations, ossification gaps, vascular channels, and Scheurmann's disease) or factors extrinsic or acquired (infection, malignancy, osteoporosis or osteomalacia, hyperparathyroidism, Paget's disease). [1][2][3][4][5] Weakening of the vertebral endplates is not an absolute prerequisite for the extrusion of intervertebral discs, only a small portion of Schmorl's nodes is formed due to weak endplates.…”