Pietrok Allyson, Lee Christopher, Kaye Rachel J, Kaye Alan D, Chesteen George
University of Nebraska College of Medicine.
Department of Internal Medicine, Creighton University School of Medicine-Phoenix Regional Campus.
Orthop Rev (Pavia). 2022 Apr 25;14(3):33641. doi: 10.52965/001c.33641. eCollection 2022.
Schmorl's nodes are herniations of nucleus pulposus through the cartilaginous and bony endplate into the adjacent vertebra. Schmorl's nodes are extremely common and are typically seen as incidental findings on radiographic imaging. In postmortem studies, it has been estimated that greater than 70% of the population has Schmorl's nodes. Rarely, however, Schmorl's nodes can be a cause of acute back pain and, even less often, radiculopathy.
In the present case, an elderly male presented with an acute onset of lower back pain and radiculopathy. MRI demonstrated a large L3 vertebral body inferior endplate Schmorl's node with posterior extension through the vertebral body cortex and into the ventral epidural space superiorly. This resulted in severe effacement of the right L2-L3 subarticular recess, as well as the right L3-L4 neural foramen, impinging on the right L3 nerve root. Surrounding cortical edema and enhancement on MRI further suggested an acute Schmorl's node.
Although rare, Schmorl's nodes can be a cause of acute back pain and, even less commonly, radiculopathy. The imaging modality of choice for the diagnosis of a Schmorl's node is MRI as it has a greater capability to detect edema, neovascularization, and in this case, extruded disc material. In both asymptomatic and symptomatic cases, the mainstay of treatment for Schmorl's nodes is conservative therapy. Surgical removal of disc material has been successful in cases of persistent radiculopathy from compression by a tunneling Schmorl's node.
施莫尔氏结节是髓核通过软骨和骨终板疝入相邻椎体。施莫尔氏结节极为常见，通常在影像学检查中作为偶然发现。在尸检研究中，估计超过70%的人群有施莫尔氏结节。然而，施莫尔氏结节很少会导致急性背痛，导致神经根病的情况则更为罕见。
在本病例中，一名老年男性出现急性下背痛和神经根病。磁共振成像（MRI）显示L3椎体下终板有一个大的施莫尔氏结节，其向后延伸穿过椎体皮质并向上进入腹侧硬膜外间隙。这导致右侧L2-L3关节下隐窝以及右侧L3-L4神经孔严重受压，压迫右侧L3神经根。MRI上周围的皮质水肿和强化进一步提示为急性施莫尔氏结节。
尽管罕见，但施莫尔氏结节可导致急性背痛，导致神经根病的情况则更为少见。诊断施莫尔氏结节的首选影像学检查方法是MRI，因为它更有能力检测水肿、新生血管，在本病例中还能检测到挤出的椎间盘物质。对于施莫尔氏结节，无论无症状还是有症状的病例，主要治疗方法都是保守治疗。对于因隧道型施莫尔氏结节压迫导致持续性神经根病的病例，手术切除椎间盘物质已取得成功。
