schmorl’s node case presentation
DESCRIPTION
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 advanceTRANSCRIPT
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Schmorl’s nodeA Case presentation
By: Dr Rekha Khare
MD Radiology
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Schmorl’s node:
• Christian George Schmorl German pathologist named it
as Schmorl’s Node in 1927
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Clinical Presentation:
• MRI has been done for a young school boyaged 18years. His main complaint was chronicbackache all over from neck to down for last few years
• On examination there was no remarkable clinicalsign There was no any other constitutionalsymptom.
• Routine laboratory examination was within normallimit.
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MRI Cervico-dorsal spine……
• Sagittal T2 sequence:
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MRI Lumbar spine T2 sagittal
Planning film:
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MRI Lumbar region……
• Sagittal T1 sequence:
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MRI Lumbar spine L4-5…..
• Axial T1 & T2 sequence:
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MRI Lumbar spine……
• Coronal T2 sequence:
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MRI Whole spine…….
• Sagittal screening whole spine:
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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
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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.
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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
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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.
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DISCUSSION:
• Vertebral end plate are critical for
maintaining disc function yet like other
components of the disc endplate are
vulnerable to degeneration.
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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
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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
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Discussion contd…….
• . It is believed that schmorls node develop
following back trauma
• Nucleus pulposus pressure on the
weakest part of endplate
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Discussion contd…….
• They may also reflect that bone strength
was at one time some what compromised
perhaps due to vitamin D deficiency
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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.
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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
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REFERENCES:
1. Dr Tim Luijks and Dr Behrang Amin etal.: Schmorl node .Radiopaedia.org.com2. Mc Fadden KD, Taylor JR: End Plate Lesion of Lumbar spineSpine 1989, 14(8):867-8693. Robert J.Moore: The vertebral end plate: Disc degeneration,discregeneration. EurSpine J.Aug 2006(suppl.3)333-3374. Takahashi K, Miyazaki T, Ohnari H, Tonita K: Schmorls nodesand low back pain- Analysis of magnetic resonance of imagingfinding in symptomatic and asymptomatic individual, Eur SpineJ.1995,4(1)56-95. Leo F. Czervionke and Douglous S. Fenton: Imaging painful spinedisorder6. Dr Henry Knipe and Dr Frank Gailard etal. : Scheuermann
disease , Radiopaedia.org .Com•