A Case of Persistent Low Back Pain in a Young Female Caused by a Trauma-Induced Schmorl's Node in the Lumbar Spine Five Vertebra

Acute Lumbar Schmorl’s Node Following Chiropractic Adjustment

Schmorl’s nodes are typically an incidental finding whereby a disc herniates into the vertebral body. The clinical course is rarely symptomatic. Here, we present a 41-year-old male who, following chiropractic manipulation, developed an acute Schmorl’s node. The patient was managed successfully with conservative measures. A 41-year-old male with acute on chronic low back pain following a chiropractic adjustment. Imaging demonstrated the development of an acute Schmorl’s node of the lumbar four-five disc into the lumbar 4 vertebral body after a chiropractic adjustment. He was treated with conservative measures with over 85% relief of back pain. Acute Schmorl’s nodes can develop after the chiropractic adjustment. In the case presented, conservative measures resulted in 85% improvement in pain.

Schmorl's nodes: demystification road of endplate defects-a critical review

BACKGROUND

Schmorl's nodes (SN) were the first vertebral endplate defects described. Debate continues about their epidemiology, physiopathology, and clinical significance. The purpose of this work was to summarize and discuss available literature about SN.

METHODS

We have searched for relevant papers about SN until April 2020, with 104 articles have been reviewed.

RESULTS

More than half of the available literature described the epidemiological aspects of SN or reported rare clinical presentations and treatment options. The lack of a consensual definition of SN, among other endplate defects, contributed to difficulties in literature results' interpretation. Summing up, SN is a frequent vertebral defect at the thoracolumbar juncture, with ethnic and gender influence. Lumbar Schmorl's nodes were frequently associated with disc degenerative disease and back pain. Their physiopathology remains unknown. However, strain energy changes in the spine along with morphological aspects of the vertebra, the genetic background, and the osteoimmunology may constitute possible clues. New SN could be confused in malignancy context with bone metastasis. The literature describes some imaging techniques to differentiate them, avoiding invasive approaches. Treatment options for rare painful presentations remain few with low evidence. Further studies are needed to establish a consensual definition for SN, understand clinical aspects, and provide adequate therapeutic strategies.

Schmorl Node-A Cause of Acute Thoracic Pain: A Case Report and Pathophysiological Mechanism

Purpose

We report a case of a patient with an acute symptomatic Schmorl node (SN) that spontaneously resolved with characteristic imaging findings. The extensive hematological investigations also allow some insight as to the likely pathophysiology of the painful lesion.

Methods

Case report of an acute symptomatic SN.

Results

A fit and athletic 44-year-old female participant in a competitive paddling event developed atypical thoracic pain and was admitted for further investigation. Normal blood results included complete blood cell count, clotting, and D-dimer. Creatine phosphokinase was 63 U/L (reference < 167 U/L) and troponin I levels were not raised. Her only hematological abnormality was an elevated C-reactive protein (CRP) at 60.2 mg/L (reference < 5 mg/L). Magnetic resonance imaging (MRI) scan showed signal hyperintensity involving T7 vertebral body, surrounding an enlarged SN. Patient was given oral nonsteroidal anti-inflammatory drugs, opioid analgesia, and gradually mobilized. After 3 days, the pain had sufficiently subsided and CRP was 17.8 mg/L. Follow-up MRI scan showed some reduction in the T2 hyperintensity and size of the intraosseous herniation. Patient gradually returned to full activities and had no recurrence of symptoms. MRI scan 8 months after the initial scan showed almost complete resolution of the T2 hyperintensity and pan-vertebral marrow edema.

Conclusion

Symptomatic SN should be part of the differential diagnosis of unexplained thoracolumbar pain. Modality of choice for diagnosis would be MRI. Once diagnosed, several treatment options are available with the most likely being spontaneous resolution of symptoms and bone healing within a few months. The conservative approach is recommended when the symptoms can be medically well controlled.