Difference between revisions of "Schmorl's node"

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'''Schmorl's nodes''' is a benign pathology of the vertebral column in which part of the vertebral disc  herniates into a vertebra.<ref name=pmid23955279>{{Cite journal  | last1 = Mattei | first1 = TA. | last2 = Rehman | first2 = AA. | title = Schmorl's nodes: current pathophysiological, diagnostic, and therapeutic paradigms. | journal = Neurosurg Rev | volume =  | issue =  | pages =  | month = Aug | year = 2013 | doi = 10.1007/s10143-013-0488-4 | PMID = 23955279 }}</ref>
'''Schmorl's node''' is a benign pathology of the vertebral column in which part of the vertebral disc  herniates into a vertebra.<ref name=pmid23955279>{{Cite journal  | last1 = Mattei | first1 = TA. | last2 = Rehman | first2 = AA. | title = Schmorl's nodes: current pathophysiological, diagnostic, and therapeutic paradigms. | journal = Neurosurg Rev | volume =  | issue =  | pages =  | month = Aug | year = 2013 | doi = 10.1007/s10143-013-0488-4 | PMID = 23955279 }}</ref>


==General==
==General==
*Very common.<ref name=pmid19531985>{{Cite journal  | last1 = Dar | first1 = G. | last2 = Peleg | first2 = S. | last3 = Masharawi | first3 = Y. | last4 = Steinberg | first4 = N. | last5 = May | first5 = H. | last6 = Hershkovitz | first6 = I. | title = Demographical aspects of Schmorl nodes: a skeletal study. | journal = Spine (Phila Pa 1976) | volume = 34 | issue = 9 | pages = E312-5 | month = Apr | year = 2009 | doi = 10.1097/BRS.0b013e3181995fc5 | PMID = 19531985 }}</ref>
*Very common.<ref name=pmid19531985>{{Cite journal  | last1 = Dar | first1 = G. | last2 = Peleg | first2 = S. | last3 = Masharawi | first3 = Y. | last4 = Steinberg | first4 = N. | last5 = May | first5 = H. | last6 = Hershkovitz | first6 = I. | title = Demographical aspects of Schmorl nodes: a skeletal study. | journal = Spine (Phila Pa 1976) | volume = 34 | issue = 9 | pages = E312-5 | month = Apr | year = 2009 | doi = 10.1097/BRS.0b013e3181995fc5 | PMID = 19531985 }}</ref>
*Essentially a radiologic diagnosis.
*Essentially a radiologic diagnosis.
*Not associated with [[osteopenia]].<ref name=pmid11756740>{{Cite journal  | last1 = González-Reimers | first1 = E. | last2 = Mas-Pascual | first2 = M. | last3 = Arnay-De-La-Rosa | first3 = M. | last4 = Velasco-Vázquez | first4 = J. | last5 = Santolaria-Fernández | first5 = F. | title = Schmorl nodes: lack of relationship between degenerative changes and osteopenia. | journal = Radiology | volume = 222 | issue = 1 | pages = 293-4 | month = Jan | year = 2002 | doi = 10.1148/radiol.2221011147 | PMID = 11756740 }}</ref>
Clinical:
*May cause severe back pain.<ref name=pmid23741552>{{Cite journal  | last1 = Abu-Ghanem | first1 = S. | last2 = Ohana | first2 = N. | last3 = Abu-Ghanem | first3 = Y. | last4 = Kittani | first4 = M. | last5 = Shelef | first5 = I. | title = Acute schmorl node in dorsal spine: an unusual cause of a sudden onset of severe back pain in a young female. | journal = Asian Spine J | volume = 7 | issue = 2 | pages = 131-5 | month = Jun | year = 2013 | doi = 10.4184/asj.2013.7.2.131 | PMID = 23741552 }}</ref>
*May be associated with trauma.<ref name=pmid1754491>{{Cite journal  | last1 = Walters | first1 = G. | last2 = Coumas | first2 = JM. | last3 = Akins | first3 = CM. | last4 = Ragland | first4 = RL. | title = Magnetic resonance imaging of acute symptomatic Schmorl's node formation. | journal = Pediatr Emerg Care | volume = 7 | issue = 5 | pages = 294-6 | month = Oct | year = 1991 | doi =  | PMID = 1754491 }}</ref>
==Radiology==
<gallery>
Image:Roe-schmorl.jpg | Schmorl's node. (WC)
</gallery>
DDx - radiologic:
*[[Plasma cell neoplasm]].
*Metastatic carcinoma.
==Microscopic==
Features:<ref name=pmid12931811>{{Cite journal  | last1 = Peng | first1 = B. | last2 = Wu | first2 = W. | last3 = Hou | first3 = S. | last4 = Shang | first4 = W. | last5 = Wang | first5 = X. | last6 = Yang | first6 = Y. | title = The pathogenesis of Schmorl's nodes. | journal = J Bone Joint Surg Br | volume = 85 | issue = 6 | pages = 879-82 | month = Aug | year = 2003 | doi =  | PMID = 12931811 | URL = http://www.bjj.boneandjoint.org.uk/content/85-B/6/879.long }}</ref>
*Subchondral [[necrosis]] of bone - '''key feature'''.
**Loss of osteocytes within the bony trabeculae.
*Reactive [[woven bone]]:
**Thickened trabeculae.
**Increased numbers of osteoblasts and osteoclasts.
*Bone marrow cavity fibrosis with small blood vessels and loss of adipocytes (reactive process).
Note:
*Histologically, ''Schmorl's node'' is considered a cousin of [[avascular necrosis of the femoral head]].<ref name=pmid12931811/>
==Sign out==
<pre>
LESION, L4 VERTEBRA, BIOPSY:
- BENIGN BONE AND BONE MARROW.
- NEGATIVE FOR MALIGNANCY.
</pre>
===Micro===
The sections show woven bone with slightly thickened bony trabeculae.  Bone with some empty
lacunae is seen focally. A small amount of benign fibrotic tissue with small blood vessels
is present. The bone marrow present has all three lineages. No atypical cells are apparent.


==See also==
==See also==
*[[Spine]].
*[[Spine]].
*[[Necrosis]].


==References==
==References==
{{Reflist|1}}
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]

Latest revision as of 12:21, 28 October 2013

Schmorl's node is a benign pathology of the vertebral column in which part of the vertebral disc herniates into a vertebra.[1]

General

  • Very common.[2]
  • Essentially a radiologic diagnosis.
  • Not associated with osteopenia.[3]

Clinical:

  • May cause severe back pain.[4]
  • May be associated with trauma.[5]

Radiology

  • Schmorl's node. (WC)

DDx - radiologic:

Microscopic

Features:[6]

  • Subchondral necrosis of bone - key feature.
    • Loss of osteocytes within the bony trabeculae.
  • Reactive woven bone:
    • Thickened trabeculae.
    • Increased numbers of osteoblasts and osteoclasts.
  • Bone marrow cavity fibrosis with small blood vessels and loss of adipocytes (reactive process).

Note:

Sign out

LESION, L4 VERTEBRA, BIOPSY:
- BENIGN BONE AND BONE MARROW.
- NEGATIVE FOR MALIGNANCY.

Micro

The sections show woven bone with slightly thickened bony trabeculae. Bone with some empty lacunae is seen focally. A small amount of benign fibrotic tissue with small blood vessels is present. The bone marrow present has all three lineages. No atypical cells are apparent.

See also

References

  1. ↑ Mattei, TA.; Rehman, AA. (Aug 2013). "Schmorl's nodes: current pathophysiological, diagnostic, and therapeutic paradigms.". Neurosurg Rev. doi:10.1007/s10143-013-0488-4. PMID 23955279.
  2. ↑ Dar, G.; Peleg, S.; Masharawi, Y.; Steinberg, N.; May, H.; Hershkovitz, I. (Apr 2009). "Demographical aspects of Schmorl nodes: a skeletal study.". Spine (Phila Pa 1976) 34 (9): E312-5. doi:10.1097/BRS.0b013e3181995fc5. PMID 19531985.
  3. ↑ González-Reimers, E.; Mas-Pascual, M.; Arnay-De-La-Rosa, M.; Velasco-Vázquez, J.; Santolaria-Fernández, F. (Jan 2002). "Schmorl nodes: lack of relationship between degenerative changes and osteopenia.". Radiology 222 (1): 293-4. doi:10.1148/radiol.2221011147. PMID 11756740.
  4. ↑ Abu-Ghanem, S.; Ohana, N.; Abu-Ghanem, Y.; Kittani, M.; Shelef, I. (Jun 2013). "Acute schmorl node in dorsal spine: an unusual cause of a sudden onset of severe back pain in a young female.". Asian Spine J 7 (2): 131-5. doi:10.4184/asj.2013.7.2.131. PMID 23741552.
  5. ↑ Walters, G.; Coumas, JM.; Akins, CM.; Ragland, RL. (Oct 1991). "Magnetic resonance imaging of acute symptomatic Schmorl's node formation.". Pediatr Emerg Care 7 (5): 294-6. PMID 1754491.
  6. ↑ 6.0 6.1 Peng, B.; Wu, W.; Hou, S.; Shang, W.; Wang, X.; Yang, Y. (Aug 2003). "The pathogenesis of Schmorl's nodes.". J Bone Joint Surg Br 85 (6): 879-82. PMID 12931811.
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