Rami Communicans Nerve Block for the Treatment of Symptomatic Schmorl's Nodes -A Case Report-

Jang, Ji Su; Kwon, Hyung Ki; Lee, Jae Jun; Hwang, Sung Mi; Lim, So Young

doi:10.3344/kjp.2010.23.4.262

Cited by 27 publications

(33 citation statements)

References 10 publications

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“…A number of studies have found SNs to be mostly localized to the lower thoracic area, between T8 and T12. Symptomatic SNs are often very painful, with visual analog scale (VAS) scores prior to treatment close to 10 on a 10-point VAS, with significant reductions in quality of life [15][16][17].…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Proponents of the embryogenic theory assert that SNs form due to a developmental insult which results in a gap in the developing vertebrae, leaving an indentation in the bone into which disc material can herniate [5]. Such indentations can conceivably be caused by abnormal regression of the notochord, incidental ossification gaps in the centrum of the vertebrae, vascular channels, or even Scheuermann's disease [15].…”

Section: Embryogenesismentioning

confidence: 99%

“…Identified candidates include osteomalacia, hyperparathyroidism, Paget's disease, infections, neoplasm, and osteoporosis [15].…”

Section: Pathologic Processesmentioning

confidence: 99%

“…Jang et al [15] reported the use of rami communicans nerve block to alleviate the symptoms of SNs. The rationale for this treatment stemmed from the known distribution of nerve endings around the IVDs and vertebral bodies.…”

Section: Rami Communicans Nerve Blockmentioning

confidence: 99%

“…The entire circumference of the vertebral bodies and IVDs is thought to be innervated by branches from these nervous plexuses [36]. Jang and colleagues [15] performed a nerve block on the gray ramus communicans at the L4 level where the SN was located. The nerve block was performed by injecting 2 mL of 1 % mepivacaine and 10 mg of triamcinolone on each side at the L4 level.…”

Section: Rami Communicans Nerve Blockmentioning

confidence: 99%

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Schmorl’s nodes

et al. 2012

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Introduction First described in 1927, a Schmorl's node (SN) is the herniation of nucleus pulposus (NP) through the cartilaginous and bony end plate into the body of the adjacent vertebra. SNs are common findings on imaging, and although most SNs are asymptomatic, some have been shown to become painful lesions. In this manuscript, we review the literature regarding the epidemiology, clinical presentation, pathogenesis, imaging, and management of SNs. Materials and methods Using databases from the US National Library of Medicine and the National Institutes of Health, relevant articles were identified. Results While several theories regarding the pathogenesis of SNs have been proposed, an axial load model appears to have the greatest supporting evidence. Symptomatic SNs are thought to be due to the inflammatory response solicited by the herniation of NP into the wellvascularized vertebral body. Management options for symptomatic SNs vary, ranging from medical management to surgical fusion. Conclusion SNs are common lesions that are often asymptomatic. In certain cases, SNs can cause back pain. No consensus on pathogenesis exists. There is no established treatment modality for symptomatic SNs.

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Section: Clinical Presentationmentioning

confidence: 99%

Section: Embryogenesismentioning

confidence: 99%

“…Identified candidates include osteomalacia, hyperparathyroidism, Paget's disease, infections, neoplasm, and osteoporosis [15].…”

Section: Pathologic Processesmentioning

confidence: 99%

Section: Rami Communicans Nerve Blockmentioning

confidence: 99%

Section: Rami Communicans Nerve Blockmentioning

confidence: 99%

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Schmorl’s nodes

et al. 2012

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Vertebral morphology influences the development of Schmorl's nodes in the lower thoracic vertebrae

Plomp

Roberts

Viðarsdóttir

2012

American J Phys Anthropol

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Schmorl's nodes are the result of herniations of the nucleus pulposus into the adjacent vertebral body and are commonly identified in both clinical and archaeological contexts. The current study aims to identify aspects of vertebral shape that correlate with Schmorl's nodes. Two-dimensional statistical shape analysis was performed on digital images of the lower thoracic spine (T10-T12) of adult skeletons from the late medieval skeletal assemblages from Fishergate House, York, St. Mary Graces and East Smithfield Black Death cemeteries, London, and postmedieval Chelsea Old Church, London. Schmorl's nodes were scored on the basis of their location, depth, and size. Results indicate that there is a correlation between the shape of the posterior margin of the vertebral body and pedicles and the presence of Schmorl's nodes in the lower thoracic spine. The size of the vertebral body in males was also found to correlate with the lesions. Vertebral shape differences associated with the macroscopic characteristics of Schmorl's nodes, indicating severity of the lesion, were also analyzed. The shape of the pedicles and the posterior margin of the vertebral body, along with a larger vertebral body size in males, have a strong association with both the presence and severity of Schmorl's nodes. This suggests that shape and/or size of these vertebral components are predisposing to, or resulting in, vertically directed disc herniation.

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