A Schmorl’s node, also known as a Schmorl’s hernia or an intravertebral disc herniation, is a condition that occurs when a portion of the intervertebral disc, protrudes into the body of the adjacent vertebra. This results in a small, often painless indentation or cavity within the vertebral body.
Schmorl’s nodes are usually asymptomatic and are often discovered incidentally on imaging studies such as CT scans, or MRI scans that are done for other reasons. In rare cases they can cause symptoms if the nodes lead to structural changes in the spine that affect its stability.
What is a Schmorl’s Node?
A Schmorl’s node, also known as an intravertebral disc herniation or intravertebral disc prolapse, is a condition that involves the intervertebral discs of the spine. Intervertebral discs are cartilage-like structures located between the vertebrae in the spine, acting as shock absorbers and allowing flexibility of the spine.
A Schmorl’s node occurs when a portion of the intervertebral disc pushes through the endplate of a vertebra and into the adjacent vertebral body. This can lead to a small protrusion or depression in the vertebral body itself.
Do Schmorl’s Nodes Cause Symptoms?
Schmorl’s nodes themselves typically do not cause symptoms. Many individuals with Schmorl’s nodes are asymptomatic and may not even be aware that they have them. These nodes are often discovered incidentally during imaging studies done for unrelated reasons.
However, in some cases, Schmorl’s nodes might contribute to back pain or discomfort. This can occur if the nodes lead to structural changes in the spine that affect its stability, alignment, or load-bearing capabilities. For example, if a Schmorl’s node causes a weakening of the vertebral endplate or leads to compression of surrounding spinal structures, it might result in localized pain or discomfort.
Are Schmorl’s Nodes Serious?
Schmorl’s nodes themselves are generally not considered serious, especially if they are asymptomatic and discovered incidentally on imaging studies. Many people have Schmorl’s nodes without experiencing any pain or discomfort, and these nodes often do not require specific treatment.
What Causes Schmorl’s Nodes?
The exact causes of Schmorl’s nodes are not fully understood, but several factors are thought to contribute to their development:
- Genetics: There may be a genetic predisposition to developing Schmorl’s nodes. Some research suggests that certain genetic factors might make individuals more susceptible to the weakening of the vertebral endplates, which can increase the risk of nodes forming.
- Mechanical Factors: Repetitive or excessive mechanical stress on the spine, such as heavy lifting or activities that involve repeated impact, can potentially contribute to the formation of Schmorl’s nodes. The repeated stress could lead to small injuries or disruptions in the cartilage of the endplate, allowing the intervertebral disc material to push through.
- Degenerative Changes: Over time, the intervertebral discs naturally undergo degenerative changes, including a decrease in water content and changes in their structure. These changes can make the discs more susceptible to herniation through the endplate.
- Osteoporosis: Weakening of the bones due to osteoporosis can affect the strength of the vertebral endplates. This weakening can make it easier for intervertebral disc material to push through and form Schmorl’s nodes.
- Trauma: Traumatic injuries to the spine, such as a fall or an accident, could potentially lead to the formation of Schmorl’s nodes if the force of the impact causes the intervertebral disc material to herniate through the endplate.
Diagnosing Schmorl’s Nodes
Schmorl’s nodes are typically diagnosed through medical imaging techniques, as they are not usually accompanied by obvious physical symptoms. Often these are found incidentally, meaning they were discovered when imaging is ordered for other reasons. The following imaging modalities are commonly used to diagnose Schmorl’s nodes:
- X-rays: X-rays can reveal changes in the shape and alignment of the vertebral bodies, which might indicate the presence of Schmorl’s nodes. However, X-rays might not always provide a detailed view of the nodes, especially if they are small or located within certain regions of the spine.
- MRI (Magnetic Resonance Imaging): MRI is a highly effective imaging method for detecting Schmorl’s nodes. It provides detailed images of soft tissues, bones, and intervertebral discs. An MRI scan can clearly show the presence of a node, its size, location, and any associated changes in the adjacent vertebral body or surrounding structures.
- CT (Computed Tomography): CT scans can also be used to diagnose Schmorl’s nodes, especially if higher-resolution images are needed to assess the exact location and extent of the nodes. CT scans provide cross-sectional images that can help visualize the nodes from different angles.
What is the Treatment for Schmorl’s Nodes?
In many cases, Schmorl’s nodes are asymptomatic and do not require specific treatment. However, if they are causing pain or discomfort, treatment options might include:
- Conservative Management:
- Rest: Taking breaks and avoiding activities that exacerbate the pain can help.
- Pain Management: Over-the-counter pain relievers or nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to manage pain and inflammation.
- Physical Therapy: A physical therapist can design exercises and stretches to strengthen the core muscles, improve posture, and alleviate pain.
- Posture Correction: Proper posture techniques can help reduce strain on the spine and alleviate discomfort.
- Back Support: Wearing a lumbar support or back brace might help alleviate pain and provide stability, especially during activities that could exacerbate symptoms.
- Injections: In some cases, corticosteroid injections can be administered near the affected area to reduce inflammation and pain.
- Surgery: Surgery is usually considered only in rare cases when conservative treatments fail and the symptoms are severe or significantly affecting the quality of life. Surgical options might involve stabilizing the spine through fusion, or addressing herniated disc material through a discectomy.
The Takeaways
A Schmorl’s node is a condition where a portion of the intervertebral disc pushes through the vertebra’s endplate, potentially causing a small protrusion in the adjacent vertebral body. While often asymptomatic and not serious, Schmorl’s nodes can contribute to back pain or discomfort if they affect spinal stability. Causes include genetics, mechanical stress, degeneration, osteoporosis, and trauma. Treatment varies, with asymptomatic cases often requiring no intervention. If symptomatic, options include rest, pain management, physical therapy, posture correction, back support, injections, and surgery in very rare cases.
Sources
Kyere KA, Than KD, Wang AC, et al. Schmorl’s nodes. Eur Spine J. 2012;21(11):2115-2121.
