施莫尔氏结节与椎体终板骨折及急性终板椎间盘突出的关系。
Relationship of Schmorl's nodes to vertebral body endplate fractures and acute endplate disk extrusions.
作者信息
Wagner A L, Murtagh F R, Arrington J A, Stallworth D
机构信息
University of South Florida College of Medicine, Department of Radiology, Tampa, USA.
出版信息
AJNR Am J Neuroradiol. 2000 Feb;21(2):276-81.
BACKGROUND AND PURPOSE
Literature regarding clinical pain syndromes associated with acute, traumatic Schmorl's nodes (SNs) is limited. Our purpose was to determine whether an SN could be related to a previous traumatic event producing either acute SN or a vertebral endplate fracture.
METHODS
Two neuroradiologists independently reviewed initial and follow-up MR examinations of 14 patients with a clinical diagnosis of acute, symptomatic thoracolumbar SNs or vertebral body endplate fractures that evolved into SNs to evaluate marrow edema, signal intensity, margin definition, presence of intravertebral extruded disk material, and pattern of contrast enhancement.
RESULTS
Edema of the affected vertebral body, adjacent to an endplate without wedging or collapse, was observed on the initial MR images in all cases. The initial MR images of six (43%) of 14 patients exhibited only edema of the marrow immediately adjacent to the endplate without wedging or collapse. The MR images obtained at the time of follow-up showed subsequent formation of a chronic and eventually asymptomatic SN for all six patients. The initial MR images of eight (57%) of the 14 patients showed the typical appearance of acute SNs with marrow edema of the affected vertebra. The contrast-enhanced images of three patients manifested enhancement of the invaginated disk material in three (100%) of three cases and enhancement of the surrounding vertebral body in one case (33%). Six (43%) of 14 patients had acute typical compression fracture of a vertebral body of at least one additional level.
CONCLUSION
Most (57%) of the SNs in this series could be traced to episodes of significant, sudden-onset, localized, nonradiating back pain and tenderness for which the MR images showed SNs surrounded by vertebral body marrow edema. The remaining SNs (43%) were not immediately apparent as SNs and manifested only as vertebral body edema representing endplate fracture but did evolve into classical chronic SNs that follow-up imaging revealed.
背景与目的
关于与急性创伤性施莫尔氏结节（SNs）相关的临床疼痛综合征的文献有限。我们的目的是确定SNs是否可能与先前导致急性SNs或椎体终板骨折的创伤事件有关。
方法
两名神经放射科医生独立回顾了14例临床诊断为急性、有症状的胸腰椎SNs或演变为SNs的椎体终板骨折患者的初始和随访磁共振成像（MR）检查，以评估骨髓水肿、信号强度、边缘清晰度、椎体内挤出的椎间盘物质的存在以及对比增强模式。
结果
所有病例的初始MR图像均显示，在无楔形变或塌陷的终板附近，受累椎体出现水肿。14例患者中有6例（43%）的初始MR图像仅显示紧邻终板的骨髓水肿，无楔形变或塌陷。随访时获得的MR图像显示，这6例患者随后均形成了慢性且最终无症状的SNs。14例患者中有8例（57%）的初始MR图像显示急性SNs的典型表现，即受累椎体出现骨髓水肿。3例患者的对比增强图像显示，3例（100%）病例中陷入的椎间盘物质增强，1例（33%）病例中周围椎体增强。14例患者中有6例（43%）至少有一个额外节段的椎体发生急性典型压缩骨折。
结论
本系列中大多数（57%）的SNs可追溯到严重、突发、局部、无放射性背痛和压痛发作，MR图像显示SNs被椎体骨髓水肿包围。其余的SNs（43%）最初并非明显为SNs，仅表现为代表终板骨折的椎体水肿，但确实演变成随访成像显示的典型慢性SNs。
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