Painful Schmorl's nodes treated by discography and discoblock

Eur Spine J. 2018 Jan;27(1):13-18. doi: 10.1007/s00586-017-4996-8. Epub 2017 Feb 13.

Abstract

Purpose: To determine the efficacy of discography and discoblock in the treatment of low back pain (LBP) associated with painful Schmorl's nodes (SNs).

Methods: Between January 2010 and February 2015, 46 patients were studied who had LBP suspected to be secondary to SNs. There were 34 men and 12 women, and mean age was 54.2 years (range 42-68 years). All patients underwent provocation discography, and discoblock was given to positive patients (confirmed to have painful SNs). Visual analogue scores (VAS) and the Oswestry Disability Index (ODI) were evaluated at 4 h and 1, 3, 6, and 12 months post-operatively. MRI was also used to evaluate the SNs at 12 months.

Results: Discography was performed on a total of 60 discs without infection or other complications. Positive findings were found in 71.7% discs; 20.0% were negative, and 8.3% were indeterminate. Among the positive patients who underwent discoblock, 89.2% reported an improvement in their LBP, and none reported worsening symptoms. VAS and ODI scores decreased significantly after discoblock, and there were no significant differences between 4 h and 1, 3, 6, and 12 months post-operatively. In patients with painful SNs, the vertebral body bone marrow surrounding the SN was characterized by low T1 and high T2 signals on MRI. At 12 months, the node demonstrated either high T1 and T2 signals or low T1 and T2 signals. The SNs tended to remain stable in size over time.

Conclusions: Painful SNs refractory to medical or physical therapy should be an indication for treatment with discography and discoblock.

Keywords: Back pain; Discoblock; Discography; Painful Schmorl’s node.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Amides / administration & dosage
  • Anesthetics, Local / administration & dosage
  • Betamethasone / administration & dosage
  • Contrast Media / administration & dosage
  • Female
  • Glucocorticoids / administration & dosage
  • Humans
  • Intervertebral Disc
  • Intervertebral Disc Degeneration / diagnosis
  • Intervertebral Disc Degeneration / therapy*
  • Intervertebral Disc Displacement / diagnosis
  • Intervertebral Disc Displacement / therapy*
  • Low Back Pain / etiology
  • Low Back Pain / therapy*
  • Lumbar Vertebrae / surgery
  • Magnetic Resonance Imaging / methods
  • Male
  • Middle Aged
  • Orthopedic Procedures / methods*
  • Pain Management / methods*
  • Pain Measurement
  • Ropivacaine
  • Severity of Illness Index
  • Treatment Outcome

Substances

  • Amides
  • Anesthetics, Local
  • Contrast Media
  • Glucocorticoids
  • Ropivacaine
  • Betamethasone

Supplementary concepts

  • Intervertebral disc disease