Acute Schmorl's Node during Strenuous Monofin Swimming: A Case Report and Review of the Literature

Abstract

Study Design This case report describes an acute Schmorl's node (SN) in an elite monofin athlete during exercise. The patient presented with severe back pain and leg numbness and was managed successfully with conservative treatment. Objective The aim of our communication was to describe a rare presentation of a common pathological condition during an intense sport. Background Swimming is not generally considered to be a sport activity that leads to spinal injuries. SNs are usually asymptomatic lesions, incidentally found on imaging studies. There is no correlation between swimming and symptomatic SN formation. Case Report A 16-year-old monofin elite athlete suffered from an acute nonradiating back pain during extreme exercise. His back pain was associated with a fracture of the superior L5 end plate and an acute SN at the L5 vertebral body with perilesional bone marrow edema. The pain resolved with nonsteroidal anti-inflammatory drugs and bed rest. The athlete had an excellent outcome and returned to his training activities 6 months after his incident. Conclusion SN should be considered in the differential diagnosis of severe back pain, especially in sport-related injuries. SNs present with characteristic imaging findings. Due to the benign nature of these lesions, surveillance-only management may be the best course of action.

Keywords: MR imaging/diagnosis; acute Schmorl's node/giant; conservative treatment; monofin swimming.

Figure 1

Imaging 1 week after injury. (A) The lateral plain film shows a lytic lesion with a thin sclerotic border (arrows). A focal depression is also evident in the L5 upper epiphyseal plate (open arrow). The sagittal (B) and axial (C) T2-weighted magnetic resonance (MR) images show a large cystic area with a low signal intensity border corresponding to a giant Schmorl's node (arrows). Reactive bone marrow edema is seen anterior to the lesion (open arrows). The L4–L5 intervertebral disc is degenerated (thick arrowheads). The sagittal (D) and axial (E) T1-weighted MR images and the corresponding images following intravenous contrast medium administration (F, G) show a “ringlike” enhancement within the sclerotic border (arrows) and anterior to the lesion (open arrow).

Figure 2

The sagittal short T1 inversion recovery (STIR) (A) and axial T2-weighted (B) magnetic resonance (MR) images 10 months after the onset of symptoms show a minor reduction of the size of the lesion and a minor increase in the signal within the nucleus pulposus of the L4–L5 disc (arrow). However, there is no surrounding edema in the bone marrow. The axial T1-weighted MR images, before (C) and after (D) contrast medium administration, show the persistent “ringlike” enhancement within the sclerotic border of the lesion.