Hasegawa K, Ogose A, Morita T, Hirata Y
Division of Orthopaedic Surgery, Niigata University Hospital, Niigata Japan.
Spinal Cord. 2004 Feb;42(2):124-8. doi: 10.1038/sj.sc.3101506.
A case report of painful lumbar Schmorl's node is presented.
To describe diagnostic evidence and the result of surgical treatment of a rare case of painful Schmorl's node.
Niigata, Japan.
A 55-year-old housewife was diagnosed with painful Schmorl's node of L3 by discography, which depicted leakage of the contrast medium into the L3 vertebra through a disruption of the central part of the cranial end plate with concomitant back pain. Segmental fusion surgery was performed. Mechanical low back pain of the patient improved just after surgery. Histologic examination demonstrated that fibrocartilaginous tissue herniated through a disruption of the superior end plate and forced into the vertebral spongiosa.
Painful Schmorl's node can be diagnosed by discography, which demonstrates an intravertebral disc herniation with concomitant back pain. Surgical treatment should be considered in a patient with persistent disabling back pain. When surgical treatment is indicated, eradication of the intervertebral disc including Schmorl's node and segmental fusion are preferable.
本文报告一例疼痛性腰椎许莫氏结节病例。
描述一例罕见的疼痛性许莫氏结节的诊断依据及手术治疗结果。
日本新潟。
一名55岁家庭主妇经椎间盘造影诊断为L3节段疼痛性许莫氏结节，造影显示造影剂通过颅侧终板中央部分破裂渗入L3椎体，同时伴有背痛。遂行节段融合手术。术后患者的机械性下背痛立即改善。组织学检查显示，纤维软骨组织通过上终板破裂处疝出并挤入椎体松质骨。
疼痛性许莫氏结节可通过椎间盘造影诊断，造影显示椎间盘内突出并伴有背痛。对于持续性致残性背痛患者应考虑手术治疗。当需要手术治疗时，切除包括许莫氏结节在内的椎间盘并进行节段融合更为可取。
