I was just involved in a 3-panel arbitration for a patient of mine injured in a motor vehicle collision. The patient did have lower thoracic disc damage. There were also Schmorl’s nodes at 3 levels in the lumbar spine. The defense tried to make the case about Schmorl’s nodes and not the disc damage. It made me realize that Schmorl’s nodes may not be well understood in the personal injury world. I want to go over a 2013 study published in the European spine journal by Stig Sonne-Holm et al. titled The epidemiology of Schmorl’s nodes and their correlation to radiographic degeneration in 4,151 subjects. They started this study by saying that little is known about Schmorl’s node etiology or cause. They reported that Schmorl’s nodes are typically thought to have been caused by one of 2 separate categories. The first category is inert developmental or congenital herniations of disc tissue into weak areas of the vertebral end-plates. The second is pathological or malignancy, trauma, infection, osteoporosis, Paget’s disease and so forth. They reported that the purpose of this study was to investigate the prevalence of Schmorl’s nodes, and the relationship between Schmorl’s nodes and degeneration, gender, age, BMI and exposure to heavy lifting. They took 4,151 lateral lumbar x-rays to include in this study. They defined Schmorl’s nodes as quote “a bell shaped, clearly delineated lesions in the central portion of the vertebral endplate in an otherwise normally looking vertebral body” End quote. This would not include endplates that clearly have damage to the endplates and degenerative changes. In school I was taught that Schmorl’s nodes were congenital findings and when seen on x-rays were incidental findings. I often seen these not even report by radiologists. This was left off of the radiologist report on the patient I started talking about. The training I got and the consensus I feel from providers is that these Schmorl’s nodes are congenital and have nothing to do with trauma or other problems. This study showed that 5% of men have Schmorl’s nodes and 3% of women have Schmorl’s nodes. They showed an overall prevalence of Schmorl’s nodes at 3.8%. They showed no statistically significant with age, weight, height, BMI, heavy lifting or manual labor. They also showed that there is no relationship with Schmorl’s nodes and overall degenerative changes. They reported that with the lack of association to increased BMI, heavy lifting, manual labor and degenerative changes that Schmorl’s nodes are quote “difficult to see them as dynamic lesions tightly associated with general or focal disease” end quote. In other words, this study supports the thought that Schmorl’s nodes are congenital incidental findings that are not associated with injuries, lifestyle or other factors. This study correlates with what I was taught in school that Schmorl’s nodes are more incidental findings and not associated with trauma or symptoms.
