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Difference between revisions of "Schmorl's node"
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'''Schmorl's | '''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| | {{Reflist|2}} | ||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||