Schmorl's Node: An Uncommon Case of Back Pain and Radiculopathy

Schmorl's nodes are herniations of nucleus pulposus through the cartilaginous and bony endplate into the adjacent vertebra. Schmorl's nodes are extremely common and are typically seen as incidental findings on radiographic imaging. In postmortem studies, it has been estimated that greater than 70% of the population has Schmorl's nodes. Rarely, however, Schmorl's nodes can be a cause of acute back pain and, even less often, radiculopathy.

In the present case, an elderly male presented with an acute onset of lower back pain and radiculopathy. MRI demonstrated a large L3 vertebral body inferior endplate Schmorl's node with posterior extension through the vertebral body cortex and into the ventral epidural space superiorly. This resulted in severe effacement of the right L2-L3 subarticular recess, as well as the right L3-L4 neural foramen, impinging on the right L3 nerve root. Surrounding cortical edema and enhancement on MRI further suggested an acute Schmorl's node.

Although rare, Schmorl's nodes can be a cause of acute back pain and, even less commonly, radiculopathy. The imaging modality of choice for the diagnosis of a Schmorl's node is MRI as it has a greater capability to detect edema, neovascularization, and in this case, extruded disc material. In both asymptomatic and symptomatic cases, the mainstay of treatment for Schmorl's nodes is conservative therapy. Surgical removal of disc material has been successful in cases of persistent radiculopathy from compression by a tunneling Schmorl's node.