Percutaneous Vertebroplasty for Symptomatic Schmorl’s Nodes: 11 Cases with Long-term Follow-up and a Literature Review

Abstract

Background: Percutaneous vertebroplasty (PVP) is commonly used to treat symptomatic vertebral compression fractures. However, its long-term effectiveness and safety for use in the treatment of symptomatic Schmorl’s nodes (SNs) refractory to conservative treatment is uncertain. Objectives: To present a case series with PVP for symptomatic SNs not responding to conservative therapy and assess the effectiveness and safety for such treatment with long-term follow-up. To present a review of the literature regarding SNs and treatment options. Study Design: Single center retrospective observational study. Setting: This study consists of patients from a large academic center in China. Methods: Between January 2008 and December 2013, 11 patients suffering from symptomatic SNs that were refractory to medical or physical therapy, underwent PVP procedures in our department. All patients had a definitive diagnosis of SNs by magnetic resonance imaging (MRI) and computed tomography (CT). The visual analog scale (VAS) was assessed preoperatively at 4 hours, at one month, and every 6 months postoperatively during the long-term (mean: 58.0 months) follow-up period. Results: Each of the 11 patients reported an immediate and distinct relief of their back pain. No one reported a worsening of symptoms. The VAS decreased from an average preprocedural score of 7.9 to a postprocedural score of 2.1 at 4 hours. The VAS averaged 1.8 during the mean followup period of 58.0 (range 24.1 to 98.9) months. There were no postoperative complications during the follow-up period. At the end of the follow-up period, all 11 patients were unrestricted in their activities. Limitations: This study is a retrospective study with a small sample size. Conclusions: PVP is an effective and safe procedure for the treatment of symptomatic SNs, which are refractory to medical or physical therapy. Key words: Percutaneous vertebroplasty, symptomatic Schmorl’s nodes, vertebral endplate fracture, endplate osteonecrosis, Modic changes