Schmorl’s node case presentation

It is a case of schmorl's node in young boy not common clinical presentation. Basically it is degenerative lesion of wear and tear as age advance

1. Schmorl’s node A Case presentation By: Dr Rekha Khare MD Radiology

2. Schmorl’s node: Christian George Schmorl German pathologist named it as Schmorl’s N ode in 1927

3. Clinical Presentation: MRI has been done for a young school boy aged 18years. His main complaint was chronic backache all over from neck to down for last few years On examination there was no remarkable clinical sign There was no any other constitutional symptom. Routine laboratory examination was within normal limit.

4. MRI Cervico -dorsal spine…… Sagittal T2 sequence:

5. MRI Lumbar spine T2 sagittal Planning film:

6. MRI Lumbar region…… Sagittal T1 sequence:

7. MRI Lumbar spine L4-5….. Axial T1 & T2 sequence:

8. MRI Lumbar spine…… Coronal T2 sequence:

9. MRI Whole spine……. Sagittal screening whole spine:

10. MRI Lumbar Spine serial sequence Lumbar curvature seems to be maintained Vertebrae are with slightly reduced height--flat vertebrae. Multilevel disc bulging, few are with low signal/ dehydrated more at L2-3,L3- 4

11. MRI FINDING CONTD……. T1 and T2 weighted sagittal MR scan of the lumbar spine showing rounded fairly central endplate cortical defects / schmorls node with herniated disc material at T12,L1,2,5 .

12. MRI FINDING CONTD……. No significant high signal due to inflammation & oedma is noted in the bone marrow surrounding the schmorls node in T2 weighted slice IV Disc spaces are not remarkably reduced

13. MRI SCREENING OF SPINE……. Central schmorls node at lower cervical 5,6,7 and multiple lower thoracic vertebrae. Minimal marginal defect at T1,2,3 Soft tissue humping in cervical region .

14. DISCUSSION: V ertebral end plate are critical for maintaining disc function yet like other components of the disc endplate are vulnerable to degeneratio n.

15. Discussion contd ……. Schmorls node is Protrusion of the cartilage of the intervertebral disc through vertebral body end plate & into adjacent vertebra . Protrusion may contact the marrow of the vertebra leading to inflammation

16. Discussion contd ……. Etiology is controversial. Schmorls node is fairly common esp with minor degeneration of the aging spine but they could be seen in younger spine often no symptom May simply reflect Wear & Tear of the spine

17. Discussion contd ……. . It is believed that schmorls node develop following back trauma Nucleus pulposus pressure on the weakest part of endplate

18. Discussion contd ……. They may also reflect that bone strength was at one time some what compromised perhaps due to vitamin D deficiency

19. Discussion contd ……. . It was yet to confirmed with studies if heavy lifting is done at younger age before the vertebra are completely ossified such as in young farm workers.

20. Discussion contd ……. It is among the diagnostic criteria of Scheuermann’s disease A Limbus vertebra is closely related to schmorls node, detected on x-ray better on CT or MRI

21. REFERENCES: 1. Dr Tim Luijks and Dr Behrang Amin etal .: Schmorl node . Radiopaedia.org.com 2. Mc Fadden KD, Taylor JR: End Plate Lesion of Lumbar spine Spine 1989, 14(8):867-869 3. Robert J.Moore : The vertebral end plate: Disc degeneration,disc regeneration. EurSpine J.Aug 2006(suppl.3)333-337 4. Takahashi K, Miyazaki T, Ohnari H, Tonita K: Schmorls nodes and low back pain- Analysis of magnetic resonance of imaging finding in symptomatic and asymptomatic individual, Eur Spine J.1995,4(1)56-9 5. Leo F. Czervionke and Douglous S. Fenton: Imaging painful spine disorder 6. Dr Henry Knipe and Dr Frank Gailard etal . : Scheuermann disease , Radiopaedia.org .Com