Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, 153 Gyeongchun Road, Guri 11923, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, 148 Gurodong Road, Seoul 08308, Republic of Korea.
Medicina (Kaunas). 2023 Oct 16;59(10):1839. doi: 10.3390/medicina59101839.
: Schmorl's nodes (SNs), formed by the herniation of intervertebral discs into adjacent vertebral bodies, are generally asymptomatic and do not require treatment. However, certain types of SNs can cause intractable back pain. : A 63-year-old man presented to our hospital with back pain after a fall 1 month prior. Physical examination revealed back pain that worsened with movement and paraspinal tenderness. Magnetic resonance imaging (MRI) performed immediately after presentation revealed subacute to chronic compression fractures with SNs at the upper endplates of the 11th and 12th thoracic and 1st lumbar vertebrae. Pain (numeric rating scale (NRS), 7-8/10) persisted despite 6 months of conservative treatment and MRI revealed increased signal intensity in T2-weighted images in the regions around the SNs. Based on these findings, an epidural nerve block was performed, and then repeated; however, no significant improvement was observed. Percutaneous vertebroplasty (PVP) was performed at the 11th and 12th thoracic and 1st lumbar vertebrae. Pain levels decreased substantially 1 week after PVP (NRS, 3-4/10). Subsequent treatment with non-steroidal anti-inflammatory drugs (NSAIDs) and steroids for two weeks further reduced pain levels (NRS, 1-2/10), following which steroid use was discontinued and NSAID use became intermittent. At the six-month follow-up, pain levels remained low and the patient reported an improvement in activity levels of 90% or more. : This case report demonstrates that PVP safely and effectively improved symptoms in a patient with multiple SNs and intractable back pain. Nevertheless, further research, particularly large-scale randomized prospective studies, is necessary to validate the long-term efficacy and safety of this intervention.
Schmorl 结节（SNs）是由椎间盘疝入相邻椎体形成的，通常无症状，不需要治疗。然而，某些类型的 SNs 可能会引起难治性背痛。
一名 63 岁男性因 1 个月前跌倒后出现背痛就诊于我院。体格检查发现，活动时背痛加重，且脊柱旁有压痛。就诊时即刻行磁共振成像（MRI）检查显示，第 11、12 胸椎和第 1 腰椎上终板处有亚急性至慢性压迫性骨折，伴有 SNs。尽管经过 6 个月的保守治疗，疼痛（数字评分量表（NRS），7-8/10）仍持续存在，且 MRI 显示 SNs 周围区域 T2 加权图像的信号强度增加。基于这些发现，进行了硬膜外神经阻滞，并重复进行，但未观察到明显改善。在第 11、12 胸椎和第 1 腰椎行经皮椎体成形术（PVP）。PVP 后 1 周，疼痛程度显著下降（NRS，3-4/10）。随后，连续两周使用非甾体抗炎药（NSAIDs）和类固醇治疗，疼痛程度进一步降低（NRS，1-2/10），之后停止使用类固醇，仅间歇性使用 NSAIDs。在 6 个月的随访时，疼痛程度仍然较低，患者报告活动水平改善了 90%或更多。
本病例报告表明，PVP 安全有效地改善了一名患有多个 SNs 和难治性背痛患者的症状。然而，需要进一步的研究，特别是大规模的随机前瞻性研究，以验证该干预措施的长期疗效和安全性。
