schmorl's nodes

[xafnndapp]

My sister in Italy is 55, after intense pain at her back for a few days (middle section, with shooting pains also at her rib-cage), she went and had X-rays taken yesterday, and they told her she has Schmorl's nodes at her D-11 vertebre.
No ostheoporosis.

She is quite fit and active, she told me that this pain began after a few days of some extra effort she did carrying something and possibly after an intense session with her chiropractic she has been  seeing regularly for a few years now. She doesn't recall something specific that she did to cause the pain to start.

Her pain is diminished but of course she wants to be reassured that it is not something really problematic.
I did a little research and saw more or less what this is about.

What's the best immediate "therapy" for her?
Rest and chiropratic? Is there something she should be avoiding doing from now on or can she have a normal life?

Thank you very much for your advice.

STEFANO

[star queen]

Schmorl's nodes are not an uncommon finding on spine radiographs. If you look at the picture, it will look much like a bite has been taken out of the bone.  Most of the population has them and doesn't know it. Your sister has probably had these all her life. Schmorl's nodes do not impinge upon the nerves of the spinal cord or cause bulging discs.  There is no treatment for them and they don't change or go away. They are generally painless, so it is doubtful that the pain your sister is having is caused from this finding.  Treatment will not be based upon this finding alone, but on her symptoms, any arthritis found, and general condition of the bone. If your sister is older than 40years of age, I suggest she talk to her MD and see about getting a bone scan (DEXA)to see about any osteoporosis risks.  good luck

[xafnndapp]

Thank you star queen.

Actually she just did a DEXA and she is absolutely fine, no ostheoporosis at all.

She actually is still in pain after one week of the diagnosis and she has to go ahead at pain killers...

[blueyed1980]

I just found out today my husband has Schmorls nodes.  He was in severe pain one day from his eyelashes to his toenails especially in the middle to upper back.  Went to the ER couldnt find out anything, just iflamation of the muscles they said and put him on muscle relaxers, Mobid, and Loracets.  Gradually got worse over next few days could not even get out of bed without help and sever pain, in tears.  He is 44 years old man and in excellent health.  Xrays showed nothing, blood work showed nothing. Finally a MRI came up with the diagnosis. as Schmorls nodes.  Yes he has a also a bulging disc as well but pain was not coming from that.  This pain went on for at least a week with severe pain with help out of bed and then trying to walk and having to stop upper back muscle spasm/pain.  After about 2 months now he is much better but still has a hard time getting enough air in to sneeze, which was impossible at the beginning of this 3-4 month timeframe.  So we are waiting on appointment tomorrow with the doctor on exact extent of this disease.  Pain I assume will return at some point , but no answers to this as of yet.  Thanks.
Debbie

[rpaylor]

This is really interesting. I have just gone through a very similar episode that started about a month and a half ago - gradually increasing pain over a weeks time (from a fall at work) that led to some of the worst pain I've ever had.  Continuous back spasms, couldn't walk or get out of bed without help.  I finally ended up in the ER, where they gave me an x-ray that was inconclusive.  Had to go back to the ER a second time because my legs and feet started going numb.  Finally got an MRI, and guess what - no typical disc herniations and no pressure on the spinal cord, but an acute schmorl's node in L2 with associated edema.  

I started reading up on this, and it seems the medical establishment has recently accepted that even though these are normally asymptomatic, the acute variety can cause severe symptoms.  This partly has to do with the central disc material, which can be highly caustic to blood-fed tissue, coming in direct contact with the blood-rich center of the vertebra.  This causes a lot of inflammation and subsequent acute pain, although this is only part of the picture, I'm sure.  

The good news, from what I understand, is that after the bone heals up properly (which they say can take months), things should be mostly back to normal, although there is a slightly higher risk of back problems in the future.  You need to be careful to NOT go to a chiropractor initially (I made that mistake).  After the bone has healed, then the chiropractor will probably be beneficial, as will some physical therapy to get some strength and flexibility back.

[kwood1]

A Schmorl's node by defitinition is basically a centralized disk herniation in which the cartilaginous end plate of the vertebral body has sustained fracturing and there was injection of disk material into this fracturing of the end plate. Thus, a Schmorl's node is a form of disk herniation. It is linked to trauma at some point in a person's life. Some people do get them in the teen years when playing sports. Recent research has shown that the material or chemical substances within a disk can cause noxious (painful) stimulus. This is also the case with a typical disk bulge or herniation. You do not have to have direct pressure on nerves to causes pain. Any time the disk loses its integrity and the nucleus shifts to a position outside of its normal confines, it begins to leak chemicals such as substance P, interleukin I, and many other big technical names. These have been found to acutally lead to a dripping of these substances onto the recurrent nerve or spinal nerve itself leading to pain like there was direct pressure on the nerve. This also explains why some people have herniations and Schmorl's nodes that are not painful and others have pain. It is when the disk is actively leaking these substances that it becomes painful. The typical model of thinking is that Schmorl's nodes are not that big of a deal. However, I can tell you by experience, many people have debilitating pain from these. Some helpful treatment notes is that traction and the newer non surgical spinal decompression works relatively good. It will not be a cure all for everyone. Everyone heals differently and there are many cofactors. People with diabetes heal slower for example. use of MSM is a natural anti-inflammatory and has been shown in research to shrink the size of disk herniations. I would also suggest B complex vitamins and use ice at home not heating pads. Disk problems are inflammation. You control inflammation with ice not heat. I have disk herniations and was once basically paralyzed in my left arm due to disk bulging. Disk bulging is seen much like a Schmorl's node. Most physicians see them as being insiginificant because the radiologist says bulge instead of herniation. Junior Bryant of the San Fran 49ers and Chris Depoto of the Colorado Rockies actually had to give up their professional sports careers from "mere" bulging.  I would also recommend Pilates and Yoga based exercises when someone's pain levels begin to decrease for stabilization. Also see a book called Pain Free by Pete Egoscue. I am not selling these products or pushing them. These are recommendations for those in spinal pain and cannot find solutions. I hope this helps.

[bundydi]

Your comments are very interesting. I have had severe low back pain with r leg pain for nearly 3 years. I cannot sit without the pain increasing and then I become nauseous. I have also over the last 6 months had very painful chest pain and it feels like I have a belt tightened around my chest. It is more painful when I breathe in. I have had a few MRI's and have been told that there is nothing surgical that can be done. The most recent MRI says I have a number of small Schmorl's nodes in the lower thoracic and upper lumbar spine and prominent posterior and right sided osteophytes related to the t4/5 and t5/6 discs. I also have Rheumatoid Arthritis.

[Bonkee]

I totally agree and appriciate your reasearch and opinion about smorl's nodes.  I think the medical comunity is unaware of the pain caused by these smorl's nodes.  I also think many people with no apparent herniation or buldge, but apparent smorl's nodes are routinely sent home with the understanding that nothing is wrong with them.  I had an injury and the same thing has happened to me, in my opinion is you get a smorls node from injury or event and its painful you must get rest becuase this irritiation will never stop if it does not have time to heal ( my present situation).  I have smorls nodes in the thorasic area extensively and have pain in my thoraisc.  One interesting finding is that when I had a discogram from T-5 to T-8 we found a symptomatic herniation in T6-T7, an asymptomatic herniation at T7-T8 and supprisingly a symptomatic disc at T5-T6 and what is there, a smorls node.  I think many of my others are symptomatic as well.  But I am no doctor.

[k will]

I have had constant severe lower back pain for 6 weeks and had begun with typical PT activities to strengthen core spine muscles ( lumbar multifidus and transversus abdominis ). After several weeks I was still in great pain and had an MRI with contrast of the lumbar spine done yesterday.  The radiologist report noted an acute Schmorl's node at L4 to the inferior endplate and related edema and swelling in the area.  I am beginning oral steroids at my Dr's recommendation but would like to better understand what options exist for repairing both the disc and the hole that has developed in the bone marrow of the vertebra.

[cowgirldollar]

I found your comments on schmorl's nodes and pain related to "bulging" disc due to chemicals that irritate the nerve interesting.  My husband has schmorl's nodes at multiple levels in the lower thoracic and upper lumbar spine and has had a recent microdiscectomy at L3-L4 with re-injury.  The recent MRI shows only bulging in the L3-L4 and L4-L5 region and he is in terrible pain radiating down into his hip and leg.  The symptoms are the same as they were when the disc was herniated before surgery but the doctors don't treat the bulging the same as the herniation but the pain is the same and the schmorl's nodes were mentioned on 2 of the 3 MRI's he has had.  I've been wondering if the schmorl's nodes were significant even though the doctors do not seem to place much significance in them.
cowgirldollar

[Hockey17]

I was diagnosed as having a schmorls node L5-S1.  (some other minor buldges L3, L4) It was found last Feb.  I have had back issues for a lot of years, but the pain from this is like no other.  I had an MRI from 2002, that that they compared to on from 2007. The pain radiates out to the outside of my hip, making it tough to walk and bend, but the pain never radiates down.  I'm 43 and an avid ice hockey player.  I ended my season early last year, and  did all the therapy thru the summer, and now I have played 1 game this fall and I'm a wreck.   Everything I read is about controlling inflammation.  Has anyone tried any herbals.  I looking at a pill that contain glucosamine, boswellia, devils claw, turmeric, and ginger.  I'm also reading about Mona-vie Active, a power juice also with glucosamine.  has anyone gone down this path?  Really want to keep skating.

[janycathy]

My 16 year old was finally diagnosed with a Schmorl's node from a cheer accident two months ago and she is suffering terribly.  Does anyone know how long this will take to heal, does it heal and what can be done?????????

[commandk]

Have a 17 year old daughter that is now being diagnosed with Schmorl's nodes.  She is a softball player and works out rigoursly during the off season with a trainer.  Has been in terrible pain.  Radiologist brother in law after two MRI's  has made diagnosis and we believe to be correct.  He thinks laying off all activity is key.  However, don't know if she is willing to do so.  Having tried PT and chiropractic, now thinking about trying accupuncture to help with the pain.

[JainMD]

Hi Jany,
What's your daughter’s name?
Schmorl nodes are intra-osseous vertebral lesions that are common findings on plain radiographs and CT and MRI scans of the spine.
These nodes represent disc material that has herniated through weak areas in the adjacent vertebral endplates into the vertebral body. In some cases, these weak areas may be the physiologic sequelae of the regression of vascular canals near the end of vertebral growth (particularly in young patients), whereas in other cases they represent a weakened endplate or sub-chondral bone.
Such herniation also may occur through pathologically weakened bone, and they usually are found in the thoracic or lumbar spine, although there have been reports of Schmorl nodes of the cervical spine.
In your daughters case I think the disc penetration may be secondary to acute trauma while playing.
Treatment is symptomatic. In the presence of an acute intra-osseous herniation, NSAIDs and rest is the mainstay of care until the patient is able to resume normal activity. Bracing may be initiated for comfort if needed.
Physical Therapy: Physical therapy may help with persistent backaches. It should consist of extensor strengthening and flexibility and endurance training.
Prognosis is generally good.
What kind of follow up have the doctor planned for your daughter?
What treatment modalities has he planned?  What is the line of management?
I would be interested to know.
Keep me informed.
Bye.

[Texas_Woman27]

My husband just found out he has a Schmor's node in his lower back.  He is 29 years old and always has severe back pain.  This was diagnosed through a Lumbar Spine X-Ray.  He doesn't like taking pain pills and can not afford insurance.  Does anyone have any suggestions?

[JainMD]

Hi Texas woman,
What is your name?
As I have told earlier, Schmorl nodes are intra-osseous vertebral lesions that are common incidental findings on plain radiographs and CT and MRI scans of the spine.
These nodes represent disc material that has herniated through weak areas in the adjacent vertebral endplates into the vertebral body.
In some cases, these weak areas may be the physiologic sequelae of the regression of vascular canals near the end of vertebral growth (particularly in young patients), whereas in other cases they represent a weakened endplate or subchondral bone.
Such herniation also may occur through pathologically weakened bone, and they usually are found in the thoracic or lumbar spine, although there have been reports of Schmorl nodes of the cervical spine.
Can you tell me what is reported on imaging study?
How is the Schmorl found out?
Is MRI being been done? What does the doctor have to say about his back pain?
What could be the cause for it?

[reducemisinformation]

A vertebralplasty is a possible solution to end the pain of schmorl's modes.  The broken ends of the vertebral bodies (back bones) are filled in with cement, allowing the disc to remain as a flat cushion between the bones, reducing inflammation.
Chiropractors and physical therapists do little to cure the pain, and in fact can cause more harm.  
The standard treatment is complete rest to allow the bones to heal, and if they don't, the first treatment might do the trick.

[Fluffysmom]

A vertebroplasty is a treatment for a compresssion fracture of vertebrae, which I have at T7.  Unfortunately, it works best if the fracture is less than a year old; mine happened 22 years ago.  I have marrow edema , which they say "may be a source of persistant pain".  I have multiple small Schmorl's nodes at opposing endplates specifically at levels T8-9, T10-11, T11-12, T12/L1.  I won't even start on my lumbar region!  Anyway, my pain has increased over the years, and I haven't been able to wear a bra for more than 8 years because of it.  If the bone heals up, then there must still be nucleus material leaking on nerves, since I have pretty intense pain.  My MRI from 5/23/07 showed "multilevel mild to moderate degenerative disc disease changes...from approximately T3 through T9, manifested as loss of disc space height, disc dehydrative changes, mild disc bulging and mild endplate spondylosis changes, also several levels of mild endplate reactive changes anteriorly.  Anyway, I went to see an interventional radiologist, who told me he didn't know why I had come to see him; it was too late to do a vertebroplasty.  My Sports & Spine doctor said there was really nothing else to do, after trying an epidural injection at T7.  Sigh!   Now I've been learning about Nucleoplasty, and wonder if it might help if my bulging discs have worsened and are contained herniations.  On December 10, 2007, I lifted my cat in his carrier, turned to go into the vet's office, and herniated L4-5.  My chest wall tightened up and muscles went into spasm and my thoracic pain is worse.  Should I ask for another thoracic MRI?  Oh, and a hip arthrogram showed that I have a 12 mm labral tear at the 12 o'clock position.   For Pete's sake!  Thanks for listening!  I'm trying to figure out (while going through epidurals and a possible cortisone shot in the hip) if I should try to get my hip repair first, or nucleoplasty or microdiscectomy first. Oh, yeah, I also have a hypermobile SI Joint.  Any ideas?

[gigi21]

I am 27 years old and I was found six schmorl's nodes in my thoracic. No medication will alliviate this horrible pain, it has been more than six years with pain, I tried therapy, pain management, cortizone and epidural injections and it does not help me at all I even had to quit my job for this pain, I really need some advices on what to do.

[JainMD]

Hi Gigi,
Schmorl nodes are intra-osseous vertebral lesions that are common incidental findings on plain radiographs and CT and MRI scans of the spine.
These nodes represent disc material that has herniated through weak areas in the adjacent vertebral endplates into the vertebral body.
In some cases, these weak areas may be the physiologic sequelae of the regression of vascular canals near the end of vertebral growth (particularly in young patients), whereas in other cases they represent a weakened endplate or subchondral bone.
Such herniation also may occur through pathologically weakened bone, and they usually are found in the thoracic or lumbar spine, although there have been reports of Schmorl nodes of the cervical spine.
Treatment is symptomatic.
In the presence of an acute intra-osseous herniation, NSAIDs and rest are the mainstay of care until the patient is able to resume normal activity.
Bracing may be initiated for comfort if needed.
Physical therapy may help with persistent backaches.
Should consist of extensor strengthening and flexibility and endurance training
Prognosis is generally good.
Complications can occur in form of loss of substantial disc space, degenerative joint disease of the facet joints may result, with additional symptoms.
If the diagnosis is unclear, or if pain does not resolve within 6 to 8 weeks, serial radiographs should be taken to ensure that the lesion does not grow or change in character.
I think you need to re-plan your imaging study and pain management with help of available resources.
Keep me informed if you have any queries.
Bye.

[Brighteyez]

Hello I have a 14 year old son, that was taken to the ER today. Woke up for school crying saying that he cant move, after many hours in the ER they told me he has Schmorl's Nodes, and Scloesis.  The doctor told him this and now he has gave up on life.  Could someone please help me I'm not sure what to do.

Thanks Penny

[JainMD]

Hi,
How is your son feeling now?
I can understand you might be feeling devastated as this is happening to your son.
What's your son’s name?
Schmorl nodes are intra-osseous vertebral lesions that are common findings on plain radiographs and CT and MRI scans of the spine.
These nodes represent disc material that has herniated through weak areas in the adjacent vertebral endplates into the vertebral body. In some cases, these weak areas may be the physiologic sequelae of the regression of vascular canals near the end of vertebral growth (particularly in young patients), whereas in other cases they represent a weakened endplate or sub-chondral bone.
Such herniation also may occur through pathologically weakened bone, and they usually are found in the thoracic or lumbar spine, although there have been reports of Schmorl nodes of the cervical spine.
Treatment is symptomatic. In the presence of an acute intra-osseous herniation, NSAIDs and rest is the mainstay of care until the patient is able to resume normal activity. Bracing may be initiated for comfort if needed.
What treatment is planned? Have the doctor's mentioned about physical therapy? If yes, what they have to say about that?
What is the treatment planned? What have they mentioned about Scoliosis? What is degree of angulations of scoliosis?
Keep me posted.
Bye.

[JainMD]

Hi,
You can also ask the doctor regarding vertebroplasty as mentioned by fluffysmom on this forum.

[Brighteyez]

Thanks so much,
His name is Michael, and I still can't get him to come out of his room.
He keeps saying that he wishs that his life was over cause all the pain he is in.
We have not get in to see his doctor yet.  They are so busy with the cold thats going around they cant get him in for 2 weeks.  So Mike is just going crazy.
Please help

Thanks

[JainMD]

Hi,
How is Mike doing?
So you have not been to doctor as of yet. Well keep me posted once you visit the doctor. Meanwhile you can treat Mike with OTC analgesics like Acetaminophen, Ibuprofen and topical analgesics ointment too.
You can take appointment of physiotherapist meanwhile so that some pain and ROM would be taken care of.
Physical therapy may help with persistent backaches.
Physical therapy should consist of extensor strengthening and flexibility and endurance training.
Good Luck.
Bye.