====== Schmorl's nodes ====== [[Schmorl's nodes]] were first described by the pathologist [[Christian Georg Schmorl]] in [[1927]] as a herniation of the [[nucleus pulposus]] through the cartilaginous and bony [[endplate]] into the [[vertebral body]]. Although such lesions present most commonly as [[incidental]] findings in asymptomatic patients (or in patients with back or [[radicular pain]] due to other [[etiology]]), there have been several reports emphasizing the deleterious effects of the inflammatory response and endplate changes elicited by the herniation of for such reasons, Schmorl's nodes have been occasionally implicated in the etiology of chronic axial pain as well as in pathological [[osteoporotic fracture]]s ((Mattei TA, Rehman AA. Schmorl's nodes: current pathophysiological, diagnostic, and therapeutic paradigms. Neurosurg Rev. 2014 Jan;37(1):39-46. doi: 10.1007/s10143-013-0488-4. Epub 2013 Aug 18. PubMed PMID: 23955279. )). ---- {{ ::schmorl_nodes.jpg?400|}} The protrusions may contact the marrow of the vertebra, leading to inflammation. ---- Among [[old]]er [[population]], many features of Schmorl's nodes parallel those of [[osteoporotic vertebral fracture]] ((Wáng YXJ, Wang XR, Leung JCS, Yu BWM, Griffith JF, Kwok TCY. Schmorl's nodes are associated with prevalent osteoporotic vertebral fracture and low bone mineral density: a population-based thoracic spine MRI study in older men and women. Quant Imaging Med Surg. 2023 Mar 1;13(3):1914-1926. doi: 10.21037/qims-22-1410. Epub 2023 Jan 13. PMID: 36915321; PMCID: PMC10006149.)) ===== Clinical presentation ===== 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. Schmörl nodes are among the diagnostic criteria of Scheuermann disease A limbus vertebra is closely related to a Schmörl node as well. ===== Pathology ===== It is believed that Schmörl nodes develop following back trauma, although this is incompletely understood. A more recent study suggests nucleus pulposus pressure on the weakest part of the endplate or vertebral development process during early life as possible explanation 7. ===== Radiographic features ===== In the acute stage, Schmörl nodes can be difficult to diagnose or detect due to sclerosis around the margin of the herniation not having had time to develop. 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 ===== They are better identified on CT images, showing the same pattern observed on radiographs. ===== MRI ===== Schmörl nodes are best seen on the sagittal sequences and usually exhibit the same signal characteristics as the adjacent disc. ===== Unclassified ===== Iampreechakul P, Lertbutsayanukul P, Suanprasert N. Acute Calcific Discitis or Symptomatic Calcified Schmorl's Node of the Upper Thoracic Spine in an Adult: A Case Report and Literature Review. Asian J Neurosurg. 2019 Jul-Sep;14(3):1021-1029. doi: 10.4103/ajns.AJNS_119_19. PubMed PMID: 31497157; PubMed Central PMCID: PMC6703016. 2: Lee JH, Park S. Differentiation of Schmorl Nodes From Bone Metastases of the Spine: Use of Apparent Diffusion Coefficient Derived From DWI and Fat Fraction Derived From a Dixon Sequence. AJR Am J Roentgenol. 2019 Nov;213(5):W228-W235. doi: 10.2214/AJR.18.21003. Epub 2019 Aug 28. 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