Title: Can an Incidental Schmorl’s Node Be a Cause for Low Backache? – Enigma Resolved By a First Ever Prospective Case Control Study in A South Indian Town Population
Authors: Saraswathi S, Adaikkapan M, Senthilnathan A, Sivakolunthu M
DOI: https://dx.doi.org/10.18535/jmscr/v4i10.96
INTRODUCTION: Schmorl’s nodes are intraosseous cartilaginous nodes representing vertical disk prolapses through areas of weakness in the vertebral endplates. Whether or not they are responsible for low backache has always been an enigma posing difficulties in giving specific treatment for the same. To our knowledge, this is the first ever prospective case control study in a south Indian town population demonstrating low backache because of Schmorl’s nodes. AIM: This study is aimed to assess the role of Schmorl’s nodes as a cause of low backache in a south Indian town population. MATERIALS AND METHODS: Hospital based Prospective Case Control Study among patients with low back ache with no known cause identified, attending the radiology department of a south Indian town hospital was done in 1.5 T MRI.Age and sex matched controls of same number without low backache were selected and studied after informed written consent. RESULTS: Of the total 568 patients presenting with low backache, 336 patients had known cause for low backache at the time of MRI. 232 patients were subjected MRI LS spine. The cause of low backache was identified in MRI spine study for 141 patients with diagnosis other than Schmorl’s nodes. Of the remaining 81 subjects, 68 had Schmorl’s nodes and no other significant pathology as a cause for their symptom and the rest 13 had normal MRI LS spine. Age and sex matched asymptomatic controls showed Schmorl’s nodes without surrounding edema in 6 individuals. The occurrence of schmorl’s node was very high in cases (84%) than in controls (7.4%). The chi-square test of association c2 = 1.239, P = 0.266 was insignificant. It was hence inferred that Schmorl’s nodes does cause low backache. CONCLUSION: Schmorl’s node does cause low backache! The knowledge of this will help clinicians do timely intervention and treat the same. KEYWORDS: Schmorl’s nodes, Low backache. 1. Coventry MB, Ghoumley RK, Kernohan JW(1945). The intervertebral disc: its microscopic anatomy and pathology. Part II. Changes in the interver- tebral disc concomitant with age. J Bone Joint Surgo1945;27:233-47. 2. Coventry MB, Ghoumley RK, Kernohan JW(1945). The intervertebral disc: its microscopic anatomy and pathology. Part III. Pathological changes in the intervertebral disc. J Bone Joint Surg1945;27:460-74. 3. B. Peng, W. Wu, S. Hou, W. Shang, X. Wang, Y. Yang(2003). The pathogenesis of Schmorl’s nodes. J Bone Joint Surg [Br] 2003;85-B:879-82. 4. Schmorl G, Junghanns H (1971). The human spine in health and diseases. Grund& Stratton, NewYork. 5. Ghelman B, Freiberger RH. An anterior disc herniation demonstrated by discog-raphy. Am J Roentgenol1976;127:854-5. 6. Seymour R, Williams LA, Rees JI, Lyons K, Lloyd DC(1998). Magnetic resonance imaging of acute intraosseous disc herniation. ClinRadiol1998;53:363-8. 7. Kyere KA, Than KD, Wang AC, Rahman SU, Valdivia-Valdivia JM, La Marca F, Park P.(2012). Schmorl's nodes. Eur Spine J. 2012 Nov;21(11):2115-21. doi: 10.1007/s00586-012-2325-9. Epub 2012 Apr 28. Review. 8. Takahashi K, Miyazaki T, Ohnari H, Takino T, Tomita K. (1995).Schmorl’s nodes and low-back pain: analysis of magnetic resonance imaging findings in symptomatic and asymptomatic individuals. Eur Spine J 1995;4:56-9. 9. Von Luschka H.(1858). Die Halbgelenke des menschlichenKörpers. Berlin: Reimer; 1858.
10. Moore KL. (1988). The developing human: clinically oriented embryology. Philadelphia: Saunders; 1988. 11. Vernon-Roberts B, Moore RJ, Fraser RD (2007) The natural history of age-related disc degeneration: the pathology and sequelae of tears. Spine (Phila Pa 1976) 32:2797–2804. 12. Hilton RC, Ball J, Benn RT. (1976). Vertebral end plate lesions (Schmorl’s nodes) in the dorsolumbar spine.Ann Rheum Dis 1976;35:127–132 13. Fahey V, Opeskin K, Silberstein M, Anderson R, Briggs C (1998) The pathogenesis of Schmorl’s nodes in relation to acute trauma. An autopsy study. Spine (Phila Pa 1976) 23:2272–2275. 14. Sward L, Hellstrom M, Jacobsson B, Nyman R, Peterson L (1991) Disc degeneration and associated abnormalities of the spine in elite gymnasts. A magnetic resonance imaging study. Spine (Phila Pa 1976) 16:437–443. 15. Swain AJ, Evans CC (2014) The Effectiveness of a Home Exercise Program for a Young Athlete with Schmorl's Nodes: A Case Report. Global J Med Clin Case Reports 1(1): 013-020. 16. Aggrawal N D, Kaur R, Kumar S, Mathur D N (1979). British Journal of Sports Medicine: 50 13(2):58-61. 17. JMSCR Vol||04||Issue||10||Page 13378-13383||October(2001). Radiologic abnormalities and Low back Pain in Elite Skiers. Clinical Orthopaedics and Related Reseaech: Vol 390;151-162. 18. Samartzis D, Karppinen J, Luk KD, Fong DY, Cheung KM. (2010). ISSLS prize winner: prevalence, determinants, and association of Schmorl nodes of the lumbar spine with disc degeneration: a population-based study of 2449 individuals. Mok FP1, Spine (PhilaPa 1976) 23:2272–2275. 19. StigSonne-Holm, Steffen Jacobsen, Hans Rovsing, HenrikMonrad (2013)The epidemiology of Schmorl’s nodes and their correlation to radiographic degeneration in 4,151 subjects. Eur Spine J. 2013 Aug; 22(8): 1907–1912. 20. Williams F.M.K, Manek N.J, Sambrook P.N, Spector T.D, Macgregor A.J.(2007). Schmorl’s Nodes: Common, Highly Heritable, and Related to Lumbar Disc Disease. Arthritis & Rheumatism (Arthritis Care & Research) Vol. 57, No. 5, June 15, 2007, pp 855–860. 21. Munsif T, Tewari V, PasrichaN,Haider S S,Siddiqui M S, Khandury S. (2014). MRI Study Of Prevalence Of Schmorl’s Node In Thoraco-Lumbar Spine. International Journal of Advanced Research (2014), Volume 2, Issue 6, 535-540. 22. Devimeenal Jagannathan, Venkatraman Indiran, Fouzal Hithaya. (2016). Prevalence and Clinical Relevance of Schmorl’s Nodes on Magnetic Resonance Imaging in a Tertiary Hospital in Southern India. Journal of Clinical and Diagnostic Research. 2016 May, Vol-10(5): TC06-TC09.Abstract
References