Abstract
BackgroundThe Schmorl’s nodes (SNs) are defined as the herniation of the intervertebral disc into the vertebral body. Endplate fractures around the Schmorl’s node could result in severe back pain that is similar to vertebral compression fractures. The objective of this study was to prospectively analyze the surgical effectiveness and safety of percutaneous vertebroplasty (PVP) for endplate fractures around the SNs.MethodsSeventy-one consecutive patients with the fresh endplate fracture around SNs from October 2017 to February 2018 were enrolled in this study. The visual analog scale (VAS) and Oswestry disability index (ODI) scores of low back pain were evaluated in all patients preoperatively, postoperatively, and at 1 month, 6 months, and 1 year after primary single level PVP. Surgery-related data including duration of the operation, injected cement volumes, and surgical complications were recorded.ResultsSixty-five patients with fresh endplate fractures around the SNs were treated successfully via percutaneous vertebroplasty. Our study showed that the VAS scores and ODI scores of patients were obviously improved after operation. Cement leakage into the disc space occurred in 5 patients (7.7%), and adjacent segment refractures occurred in 2 patients (3.1%). No other surgical complications, including infections or nerve root injuries were encountered.ConclusionsBased on the results of this prospective study, PVP was an effective and safe procedure for endplate fractures around the SNs.Trial registrationChiCTR, ChiCTR1800016453. Registered 2 June 2018—retrospectively registered,http://www.chictr.org.cn/com/25/historyversionpuben.aspx?regno=ChiCTR1800017602
Highlights
The Schmorl’s nodes (SNs) are defined as the herniation of the intervertebral disc into the vertebral body
Patient population Seventy-one consecutive patients with the fresh endplate fracture around SNs from October 2017 to February 2018 were enrolled in this study
For these patients who were resistant to conservative treatments, surgical interventions were performed; (2) SNs at the thoracic or lumbar spinal vertebral body confirmed by preoperative computed tomogram (CT)(Fig. 1) and MRI (Fig. 2); (3) spine magnetic resonance imaging showing high signal intensity on fat-suppression sequences in the single-level endplate around SNs with or without low signal intensity on T1WI and high signal intensity on T2WI; (4) the treatment of percutaneous vertebroplasty alone; (5) regular follow-ups after discharge
Summary
The Schmorl’s nodes (SNs) are defined as the herniation of the intervertebral disc into the vertebral body. Endplate fractures around the Schmorl’s node could result in severe back pain that is similar to vertebral compression fractures. The objective of this study was to prospectively analyze the surgical effectiveness and safety of percutaneous vertebroplasty (PVP) for endplate fractures around the SNs. Schmorl’s nodes (SNs), defined as herniation of the discs into the vertebral body through the endplate, were firstly described by the Christian Georg Schmorl in 1927 [1]. SNs are common spinal lesions in the asymptomatic population. The prevalence of SNs varies from 2 to 76% [2,3,4] with increased frequency in male population (76% of cases) [5]. Recent studies show that SN development is related to subchondral osteonecrosis and abnormal development of the vertebra blood vessels [7, 8]
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