Painful Schmorl’s nodes treated by discography and discoblock

Liu, Junhui; Lü, Hao; Zhang, Xuyang; Shan, Zhi; Li, Shengyun; Fan, Shunwu; Zhao, Fengdong

doi:10.1007/s00586-017-4996-8

Cited by 14 publications

(7 citation statements)

References 21 publications

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“…SNs could cause chronic back pain through inflammatory mediators and cytokines, which are produced by degenerative disc (annulus rupture) and osteonecrosis of the endplate [ 26 ]. Pathophysiological mechanisms of painful SNs are identified with the degenerative disc diseases, resulting in a special type of discogenic back pain, in which provocative discography is typically positive and spinal MRI shows a low signal intensity on T1WI, and a high signal intensity on T2WI (Mordic-I change), indicating degenerative changes of the disc material [ 25 ]. Surgical procedures including spinal fusion and discoblock can be used to manage this type of painful SN [ 25 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Background The Schmorl’s nodes (SNs) are defined as the herniation of the intervertebral disc into the vertebral body. Endplate fractures around the Schmorl’s node could result in severe back pain that is similar to vertebral compression fractures. The objective of this study was to prospectively analyze the surgical effectiveness and safety of percutaneous vertebroplasty (PVP) for endplate fractures around the SNs. Methods Seventy-one consecutive patients with the fresh endplate fracture around SNs from October 2017 to February 2018 were enrolled in this study. The visual analog scale (VAS) and Oswestry disability index (ODI) scores of low back pain were evaluated in all patients preoperatively, postoperatively, and at 1 month, 6 months, and 1 year after primary single level PVP. Surgery-related data including duration of the operation, injected cement volumes, and surgical complications were recorded. Results Sixty-five patients with fresh endplate fractures around the SNs were treated successfully via percutaneous vertebroplasty. Our study showed that the VAS scores and ODI scores of patients were obviously improved after operation. Cement leakage into the disc space occurred in 5 patients (7.7%), and adjacent segment refractures occurred in 2 patients (3.1%). No other surgical complications, including infections or nerve root injuries were encountered. Conclusions Based on the results of this prospective study, PVP was an effective and safe procedure for endplate fractures around the SNs. Trial registration ChiCTR, ChiCTR1800016453. Registered 2 June 2018—retrospectively registered, http://www.chictr.org.cn/com/25/historyversionpuben.aspx?regno=ChiCTR1800017602

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Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…Hasegawa et al [ 23 ] presented a typical case of the eradications of intervertebral nucleus pulposus containing a SN and posterior lumbar interbody fusions to solve the symptomatic SN. Several other treatment methods, such as ramus communicans nerve blockade, discography, and discoblock have been proposed for the management of back pain secondary to suspected symptomatic SNs [ 8 , 24 ]. These techniques can provide rapid and lasting symptom relief.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with symptomatic SNs may have pain on manual compression and percussion of the vertebra similar to that of a traumatic vertebral compression fracture [ 6 ]. Symptomatic SNs are much less frequently identified on routine images than are their asymptomatic counterparts, and they have been described in the literature only in isolated case reports [ 7 , 8 ]. Some research has indicated that these symptomatic SNs might either respond to conservative therapies such as analgesics, bed rests, and external bracings, or heal spontaneously in most instances.…”

Section: Introductionmentioning

confidence: 99%

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

Sun

Zhao

et al. 2017

Med Sci Monit

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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.

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“…In a prospective study of 223 patients with chronic LBP who underwent fluoroscopically guided lumbar discography and received intradiscal antibiotics prior to the procedure, no infections were recorded (16). Similarly, in a case series of 46 patients who underwent lumbar discography under fluoroscopic guidance to treat LBP caused by Schmorl nodes, no infections were reported within 1 year postprocedure (17).…”

Section: Discographymentioning

confidence: 99%

Infections Following Interventional Spine Procedures: A Systematic Review

et al. 2021

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BACKGROUND: Interventional spine procedures, such as discography, epidural steroid injections (ESIs), facet joint procedures, and intradiscal therapies, are commonly used to treat pain and improve function in patients with spine conditions. Although infections are known to occur following these procedures, there is a lack of comprehensive studies on this topic in recent years. OBJECTIVES: To assess and characterize infections following interventional spine procedures. STUDY DESIGN: Systematic review. METHODS: Studies that were published from January 2010 to January 2020 and provided information on infections or infection rates following discography, ESIs, facet joint procedures, and intradiscal therapies were included. PubMed (Medline), EMBASE, and Cochrane Library databases were searched, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Infection data were extracted from included studies, and infection rates were calculated for each procedure type. Case reports and infection-only articles were not included in infection rate calculations. RESULTS: Seventy-two studies met the eligibility criteria and were included in the systematic review. The overall incidence of infection across all studies was 0.12% (231/200,588). The majority of studies (n = 51) were linked to ESIs. Infections related to ESIs were more common than those related to discography or facet joint procedures (0.13% [219/174,431] vs. 0% [0/269] or 0.04% [9/25,697], respectively). Intradiscal therapies had the highest calculated rate of infections (1.05%; 2/191). Quality assessments of the included studies ranged widely. LIMITATIONS: There was an abundance of case reports in comparison to other study designs; to minimize skewing of the analysis, case reports and infection-only articles were not included in the infection rate. Studies that reported combined infection data for multiple procedures could not be included. Many cohort studies and case series were of lower quality because of their retrospective nature. Additionally, the true incidence of infections related to these procedures is unknown because the majority of these infections often go unreported, and information on regions of the spine and procedure details are often lacking. CONCLUSIONS: Based on our systematic review, the risk of infections following interventional spine procedures appears to be low overall. More studies focusing on infectious complications with larger sample sizes are needed, particularly for intradiscal therapies, in which the microbiome may be an underlying cause of disc infection. To achieve a true incidence of the risk of infections with these procedures, large prospective registries that collect complication rates are necessary. KEY WORDS: Infectious complications, infection incidence, interventional spine procedure, epidural steroid injection, discography, facet joint procedure, intradiscal therapies, biologics

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Painful Schmorl’s nodes treated by discography and discoblock

Abstract: Painful SNs refractory to medical or physical therapy should be an indication for treatment with discography and discoblock.

Cited by 14 publications

References 21 publications

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

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

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

Infections Following Interventional Spine Procedures: A Systematic Review

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