Schmorl's node

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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

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:

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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.