Neurobionplus
Home About Journal AHEAD OF PRINT Current Issue Back Issues Instructions Submission Search Subscribe Blog    
Login 

Users Online: 1203 
Print this page  Email this page Small font sizeDefault font sizeIncrease font size 
SPINE
Year : 2006  |  Volume : 40  |  Issue : 3  |  Page : 168-172

Intraosseous disc prolapse: A diagnostic puzzle


PD Hinduja National Hospital and Medical Research Centre, Mumbai and Sancheti Institute for Orthopaedics and Rehabilitation, Pune, India

Correspondence Address:
Rajesh Parasnis
Consultant Spine Surgeon, Archis Bunglow, 35/98, Bhusari Colony, Paud Road, Kothrud, Pune-411038
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5413.34485

Rights and Permissions

Background : Schmorl's node or intraosseous disc prolapse is herniation of the nucleus pulposus material through the vertebral end plates. Presence of Schmorl's nodes as end plate lesions following trauma, tumours and osteoporosis further complicates diagnosis. The present study was done to understand diagnosis and approach to management of symptomatic Schmorl's nodes. Methods : During a period of three years we came across 14 patients who presented with severe back pain. Conventional radiographs, CT Scans and MRI showed the presence of end plate lesions with varied radiological appearance. The first group, comprising of seven patients had lytic lesions without any sclerosis on only one side of the intervertebral disc as seen on the CT scan. The second group comprising of five patients had sclerotic lesions with new bone formation associated with disc space reduction. The two patients in the third group showed a combined lytic and sclerotic lesion without any soft tissue changes. MRI of eleven patients revealed hypointense lesion on T 1 and T 2 weighted images with surrounding zone of hyper intensity on T 2 weighted images. The remaining three patients, did not have this hyper intense zone on T 2 weighted images . In five patients multiple Schmorl's nodes were observed. Diagnosis of symptomatic Schmorl's nodes was mainly done by exclusion. All patients were given rest and anti-inflammatory drugs followed by exercises. Results : The first two groups of patients responded to the treatment and had complete relief of symptoms but both the patients in third group had persistent symptoms. MRI repeated after eight weeks showed an enhancing lesion with prevertebral soft tissue. A transpedicular core biopsy proved the lesion to be tuberculosis in one patient. Anti Koch's therapy was promptly started and follow up study showed resolution of the lesions. At the end of the study period all the patients were asymptomatic and returned to their active profession. Conclusion : The difficulty in diagnosis is attributed to the fact that every person with Schmorl's node is not symptomatic. For accurate diagnosis it is necessary to have high index of suspicion, close follow up and exclusion of other associated conditions. In case of poor response to conservative treatment an alternative diagnosis has to be considered and if required it should be proved or disproved by a biopsy of the lesion (percutaneous or open).


[FULL TEXT] [PDF]*
Print this article     Email this article
 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
 Citation Manager
 Access Statistics
 Reader Comments
 Email Alert *
 Add to My List *
 * Requires registration (Free)
 

 Article Access Statistics
    Viewed7872    
    Printed130    
    Emailed2    
    PDF Downloaded188    
    Comments [Add]    

Recommend this journal