Schmorl node induced multiple radiculopathy: A rare case report
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Published on: November 23, 2017
Yongjie Chen1, Guojun Wei, Zongguang Li
1Department of Orthopedic Surgery, Xiang'an Hospital of Xiamen University, Xiamen City, Fujian Province, China.
Rationale:
We report a case of Schmorl node induced multiple radiculopathy.
Patient Concerns:
A 70-year-old female patient complained of lower back pain in the left leg accompanied by numbness and weakness.
Diagnosis:
Radiographs showed obvious osteoporosis in the lumbar vertebrae. Computed tomography demonstrated a hole in the upper posterior half of the L2 vertebral body. Magnetic resonance imaging of the lumbar spine revealed a herniated disc involving a protrusion at the posterior wall of the L2 vertebral body, which was present in the left lateral and dorsal epidural spaces. There was significant lumbar stenosis at the L2 vertebral body secondary to dural sac compression due to the mass.
Intervention:
Left-sided hemilaminectomy was performed at L2 with screw fixation at L1-3. Intraoperatively, the severely ruptured disc compression in the dural sac and nerve root was removed.
Outcomes:
The patient's leg pain was immediately resolved, and her back pain was reduced. The patient recovered normal motor function at 20 days after surgery.
Lessons:
A Schmorl node can progress and break through the lumbar vertebral body, resulting in nerve compression. A large proximal herniated mass can cause distal multiple radiculopathy. Therefore, this special case of Schmorl node with multiple radiculopathy should be treated by removing the proximal herniated nucleus pulposus from the vertebral body.