Schmorl nodes
Updates to Synonym Attributes
Updates to Article Attributes
Schmorl nodes, also referred as intravertebral disc herniations,refer to protrusions of the cartilage of the intervertebral disc through the vertebral body endplate and into the adjacent vertebra. The protrusions may contact the marrow of the vertebra, leading to inflammation.
Clinical presentation
They may or may not be symptomaticQuiescent Schmorl nodes are extremely common found in around 75% of autopsies, at all ages, more frequently in males 9. They are usually asymptomatic, and their etiological significance for back pain is controversial. Schmörl
Acute Schmorl nodes, in contrast, are found in 40-75% of autopsiesuncommon and are associated with inflammation and symptoms 9.
Schmorl nodes are among the diagnostic criteria of Scheuermann disease6.
A limbus vertebra is closely related to a Schmorl node as well.
Pathology
It is believed that Schmorl nodes develop following back trauma, although this is incompletely understood. A more recent study suggests nucleus pulposus pressure on the weakest part of the end plate or vertebral development process during early life as possible explanation 7.
Radiographic features
In the acute stage, Schmorl nodes can be difficult to diagnose on plain radiography or detect due to sclerosis around the margin of the herniation not having had time to develop.
RadiographPlain radiographs
Usually, they are small nodular lucent lesions involving the inferior endplate of lower thoracic and lumbar vertebral bodies. However, the involvement of both the inferior and the superior endplates is not uncommon. A sclerotic margin may be present.
CT
TheySchmorl nodes are better identified on CT images, showing the same pattern observed on radiographs.
MRI
Schmorl nodes are best seen on the sagittal sequences and usually exhibit the same signal characteristics as the adjacent disc, with a thin rim of sclerosis at the margins.
Acute herniation can appear more aggressive with surrounding bone marrow oedema and peripheral enhancement 9. These acute features evolve gradually over months 9.
FDG-PET
Acute Schmorl nodes have been reported to be FDG-PET avid 9.
History and etymology
It is named after Christian Georg Schmorl(1861-1932), a German pathologist who first described them in 19279.
Differential diagnosis
For chronic Schmorl nodes there is little differential as they have characteristic appearances. Acute herniation on the other hand needs to be distinguished from discitis osteomyelitis and malignancy 9.
-<p><strong>Schmorl nodes, </strong>also referred as <strong>intravertebral herniations</strong>,<strong> </strong>refer to protrusions of the cartilage of the <a href="/articles/intervertebral-disc">intervertebral disc</a> through the vertebral body endplate and into the adjacent <a href="/articles/vertebra">vertebra</a>. The protrusions may contact the <a href="/articles/bone-marrow">marrow</a> of the vertebra, leading to inflammation.</p><h4>Clinical presentation</h4><p>They may or may not be symptomatic, and their etiological significance for back pain is controversial. Schmörl nodes are found in 40-75% of autopsies.</p><p>Schmorl nodes are among the diagnostic criteria of <a href="/articles/scheuermann-disease-2">Scheuermann disease</a> <sup>6</sup>.</p><p>A <a href="/articles/limbus-vertebra">limbus vertebra</a> is closely related to a Schmorl node as well.</p><h4>Pathology</h4><p>It is believed that Schmorl nodes develop following back trauma, although this is incompletely understood. A more recent study suggests <a href="/articles/nucleus-pulposus">nucleus pulposus</a> pressure on the weakest part of the end plate or vertebral development process during early life as possible explanation <sup>7</sup>.</p><h4>Radiographic features</h4><p>In the acute stage, Schmorl nodes can be difficult to diagnose or detect due to sclerosis around the margin of the herniation not having had time to develop. </p><h5>Radiograph</h5><p>Usually, they are small nodular lucent lesions involving the inferior endplate of lower thoracic and lumbar vertebral bodies. However, the involvement of both the inferior and the superior endplates is not uncommon. A sclerotic margin may be present. </p><h5>CT</h5><p>They are better identified on CT images, showing the same pattern observed on radiographs.</p><h5>MRI</h5><p>Schmorl nodes are best seen on the sagittal sequences and usually exhibit the same signal characteristics as the adjacent disc. </p><h4>History and etymology</h4><p>It is named after <strong>Christian Georg Schmorl</strong><strong> </strong>(1861-1932), a German pathologist who first described them in 1927.</p>- +<p><strong>Schmorl nodes, </strong>also referred as <strong>intravertebral disc herniations</strong>,<strong> </strong>refer to protrusions of the cartilage of the <a href="/articles/intervertebral-disc">intervertebral disc</a> through the vertebral body endplate and into the adjacent <a href="/articles/vertebra">vertebra</a>. The protrusions may contact the <a href="/articles/bone-marrow">marrow</a> of the vertebra, leading to inflammation.</p><h4>Clinical presentation</h4><p>Quiescent Schmorl nodes are extremely common found in around 75% of autopsies, at all ages, more frequently in males <sup>9</sup>. They are usually asymptomatic, and their etiological significance for back pain is controversial. </p><p>Acute Schmorl nodes, in contrast, are uncommon and are associated with inflammation and symptoms <sup>9</sup>. </p><p><span style="line-height:1.6">Schmorl nodes are among the diagnostic criteria of </span><a style="line-height: 1.6;" href="/articles/scheuermann-disease-2">Scheuermann disease</a><span style="line-height:1.6"> </span><sup>6</sup><span style="line-height:1.6">. </span>A <a href="/articles/limbus-vertebra">limbus vertebra</a> is closely related to a Schmorl node as well.</p><h4>Pathology</h4><p>It is believed that Schmorl nodes develop following back trauma, although this is incompletely understood. A more recent study suggests <a href="/articles/nucleus-pulposus">nucleus pulposus</a> pressure on the weakest part of the end plate or vertebral development process during early life as possible explanation <sup>7</sup>.</p><h4>Radiographic features</h4><p>In the acute stage, Schmorl nodes can be difficult to diagnose on plain radiography or detect due to sclerosis around the margin of the herniation not having had time to develop. </p><h5>Plain radiographs</h5><p>Usually, they are small nodular lucent lesions involving the inferior endplate of lower thoracic and lumbar vertebral bodies. However, the involvement of both the inferior and the superior endplates is not uncommon. A sclerotic margin may be present. </p><h5>CT</h5><p>Schmorl nodes are better identified on CT images, showing the same pattern observed on radiographs.</p><h5>MRI</h5><p>Schmorl nodes are best seen on the sagittal sequences and usually exhibit the same signal characteristics as the adjacent disc, with a thin rim of sclerosis at the margins. </p><p>Acute herniation can appear more aggressive with surrounding bone marrow oedema and peripheral enhancement <sup>9</sup>. These acute features evolve gradually over months <sup>9</sup>. </p><h5>FDG-PET</h5><p>Acute Schmorl nodes have been reported to be FDG-PET avid <sup>9</sup>. </p><h4>History and etymology</h4><p>It is named after <strong>Christian Georg Schmorl</strong><strong> </strong>(1861-1932), a German pathologist who first described them in 1927 <sup>9</sup>.</p><h4>Differential diagnosis</h4><p>For chronic Schmorl nodes there is little differential as they have characteristic appearances. <br><br>Acute herniation on the other hand needs to be distinguished from <a title="Discitis-osteomyelitis" href="/articles/spondylodiscitis">discitis osteomyelitis</a> and malignancy <sup>9</sup>. </p>
References changed:
- 9. Diehn F, Maus T, Morris J et al. Uncommon Manifestations of Intervertebral Disk Pathologic Conditions. Radiographics. 2016;36(3):801-23. <a href="https://doi.org/10.1148/rg.2016150223">doi:10.1148/rg.2016150223</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/27082664">Pubmed</a>
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