Let’s Dispel The Myth: Trauma Can Cause Schmorl's Nodes

It’s not that Schmorl’s nodes are mythical, they actually do occur. The problem is doctors and scientists like to give conditions they discover cute (and sometimes not so cute) names that are really not very descriptive of the physiology of the actual condition. Such is the case with Schmorl’s nodes.  

First described by Schmorl in 1927, a Schmorl’s node has classically been known to be due to any process which weakens the cartilaginous endplate or the subchondral cancellous bone. Schmorl’s nodes have been most commonly associated with Scheurman’s disease, Paget’s disease, degenerative joint disease, sickle cell anemia and malignant tumors. Essentially they occur because some physicologic process has gone awry, weakened the bony end-plate of the vertebral body and as the bone weakens, pressure from the disc pushes and deforms upward into the vertebral body.

When physicians see Schmorl’s nodes on x-ray, CT-scan or MRI it is typically brushed off as an incidental finding-regardless if the area is symptomatic or not. Although radiology text books always mention trauma is a possible cause, it’s always at the very bottom of the list of potential diagnoses and usually never given a second thought.  I think this needs to change.

Multi-level Schmorl's Nodes (fracture-herniation)

 

2 studies published in Spine (V. Fahey et. al.) 1998 and the American Journal of Neuroradiology (Wagner, et. al. 2000) seem to bring the Schmorl’s node phenomenon to the top of the list when there is spinal pain caused by a trauma in an area where a Schmorl’s node is present. These papers show that not only can trauma cause a Schmorl’s node but most (57%) of the Schmorl’s nodes in 2000 AJNR study  were traced to episodes of “significant, sudden-onset, localized, non-radiating back pain and tenderness for which the MRI images showed Schmorl’s nodes surrounded by vertebral body marrow edema”.

Now that we know Schmorl’s nodes are occurring from trauma more often than originally thought, what exactly is a traumatically caused Schmorl’s node?  That’s a very simple answer. With a strong annulus and enough pressure placed on the intervertebral disc from the forces involved in car accidents, falls and other trauma;  the force takes the path of least resistance, fracturing and herniating their way up through the inferior and/or down through superior end plate of the vertebra - fracturing its way into the spongy bone. 

Bottom line, if you find yourself having pain after trauma and your x-rays, CT scan, or MRI shows a Schmorl's node(s) in the area of your injury, then you can bet that the Schmorl's node was caused by the trauma. Just rule out the other Schmorl's node-associated conditions first.  Now you just have to find a physician open-minded enough to read the research and work with you to resolve your symptoms.

Todd M. Narson, DC, DACBSP®

 References: 

1) Yochum & Rowe; Essentials of Skeletal Radiology; p. 114 
2) Paul & Juhl; The Essentials of Roentgen Interpretation 
3) V. Fahey MBBS; et al.; The Pathogenisis of Schmorl’s Nodes in Relation to Acute Trauma. Spine 1998;23:2272-2275 
4) Wagner AL, Murtagh FR, Arrington JA, Stallworth D, American Journal of Neuroradiology 2000 Feb;21(2):276-81; Relationship of Schmorl's nodes to vertebral body endplate fractures and acute endplate disk extrusions.

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Dr. Narson is a 2-term past president of the Florida Chiropractic Association’s Council on Sports Injuries, Physical Fitness & Rehabilitation and was honored as the recipient of the coveted Chiropractic Sports Physician of the Year Award in 1999-2000. He practices in Miami Beach, Florida at the Miami Beach Family & Sports Chiropractic Center; A Facility for Natural Sports Medicine.


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