Lumbar Schmorl nodes usually remain asymptomatic. Painful nodes either heal spontaneously or respond to conservative therapy in most instances. Diagnosis and treatment may be difficult in patients presenting with chronic back pain. We present a 31-year-old man with a lumbar Schmorl node that was unrecognised for 10 years as the origin of his severe chronic back pain. Finally, MRI revealed a significant oedematous rim around a huge Schmorl node in the L4 vertebra. After conservative therapy failed the patient underwent a successful fluoronavigation-assisted, percutaneous vertebroplasty. In the absence of other pathological conditions, an oedematous rim around the node (as seen on MRI) is probably the pain generator in chronic back pain. We believe that the relevant nociceptors are located in the oedematous rim and not in the node itself. Therefore, cement augmentation of the rim is expected to be a successful treatment. Fluoronavigation facilitates safe access to the vertebral body.