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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Back Pain - Car Accident & A Hidden Fracture Herniation; Could An Acute Traumatic Schmorl's Node Be At Fault?

Never heard of a Schmorl's node? Then this may be of interest to you.  Think a Schmorl's node is a normal variant see on x-ray or MRI? Then this may be of interest to you too.

Yep, it’s happened again. Putting a doctor’s name on some condition and making it sound totally benign! It’s too bad, but more and more research is proving my theory true. About 8 years ago, I had a patient who kept on returning with complaints of lower back pain, yet nothing positive on the lumbar MRI. It puzzled me and then I re-read the MRI report and that’s when it hit me. Schmorl’s nodes!!! 

Often times in life we get so use to calling things by the casual names we assign them, forgetting what they really are. For example, a soldier will talk about “Collateral Damage” when they actually mean they've killed an innocent civilian or they've blown up the wrong building. The term “co-lateral damage” sounds much less severe than what had actually taken place. Unfortunately, collateral damage happens.    In the world of medicine,  doctors and scientists often assign their own names to discoveries they make. This has been a common practice for over one-hundred years. Some nice doctors will honor their patient by naming a newly discovered disease or condition after the patient who presented with the disease. These names tend to make the diseases, conditions and tests more palatable for the general public. And for good reason., some of the actual medical/scientific names are so long that they are just too difficult for many to comprehend. So we give them simple benign names. Hence the term “Schmorl’s Nodes”. 

Since I last wrote about them I had a conversation with a neuroradiologist about the phenomenon of acute-traumatic Schmorl’s nodes. I explained to him that if there is enough pressure and the outer fibers of the disc are in great-healthy shape, the force must go somewhere…up through and into the vertebral body. We discussed it a bit further and told me that if I could find it in the American Journal of Neuroradiology, then you’ve got something. So I researched it and found the reference I was looking for, and here it is: 

AJNR Am J Neuroradiol 2000 Feb;21(2):276-81; Relationship of Schmorl's nodes to vertebral body endplate fractures and acute endplate disk extrusions. Wagner AL, Murtagh FR, Arrington JA, Stallworth D. University of South Florida College of Medicine, Department of Radiology, Tampa, USA 

Classically, radiologists and clinical physicians shrugged off Schmorl’s nodes as an incidental finding having nothing to do with acute trauma. However, the more and more I read, the more I find out that these "incidental findings" were actually caused by prior traumatic events and were (again) shrugged off because doctors succumbed to convention and didn't think outside the box. 

Simply put, a Schmorl’s Node is a disc that has herniated up through the bony vertebral endplate and into the body of the vertebrae. It is a herniation that fractured through the bottom or top of the vertebrae. Even more simple, it’s a fracture-herniation! 

So now it’s out in the open. There has been enough research to prove it and from more recent casual browsing of on-line research reports, there's more support since the 2000 publication of the reference above. 

The next time a physician says the MRI or X-ray report is negative, the patient is still in pain and there was an acute trauma as the cause for the patient's pain...go back and read that radiology report again and see if there are any Schmorl's nodes. Ruling out the other causes of a Schmorl's node could leave the not-so-obvious fracture-herniation as the only diagnosis left standing. 

Contact me if you have any questions.

Dr Todd Narson
Miami Beach, FL

 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 Feb;21(2):276-81; Relationship of Schmorl's nodes to vertebral body endplate fractures and acute endplate disk extrusions.

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.

#chiropractormiamibeach #MiamiBeachChiropractor #SportsInjuriesFixedHere #DrNarson #TriDoc #TriathlonDoc #ChiropracticSportsMedicine #ACASC #SportsMedicine #MiamiBeachSportsMedicine #SportsMedicineMiami #MiamiSportsMedicine #MiamiChiropractor #Triathlon #Running #Ironman #IFixPeopleInPain #TrainWithoutPain #MiamiBeachChiropractor #GrastonTechnique #FAKTR #IASTM #Chiropractor #FootPain #Narson #NarsonBodyMechanic #NarsonTool #DACBSP #CCSP #ACBSP #BackPain #NeckPain #ShoulderPain #RotatorCuff #ITBandSyndrome #runnersKnee #PlantarFasciitis #Plantarfascitis #AchillesTendonitis #AchillesTendonosis #GettingAthletesBackInTheGame  #MiamiBeachChiropractor #MiamiSportsMedicine #MiamiBeachSportsMedicine #WeFixPeopleInPain #TrainWithoutPain #ChiropracticSportsMedicine #ACASC #ProSportChiropractic #FunctionalMedicineMiami #DrNarson #BackPainRelief #NeckPainRelief #SportsInjuriesFixedHere #LaserTherapy #RockTape #KinesioTape #KTTape #Nutrition #21DayPurificationProgram #DetoxProgram #PaleoDiet #PaleoDoc #FunctionalNutrition #MVA #CarAccidentPainRelief #CarAccidentTreatment #CarAccidentTreatmentMiami #CarAccidentTreatmentMiamiBeach