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Case Reports
. 2020 May 2;21(1):280.
doi: 10.1186/s12891-020-03276-4.

Infected Schmorl's node: a case report

Hyeun Sung Kim  1 , Harshavardhan Dilip Raorane  2 , Sagar Bhupendra Sharma  2 , Pang Hung Wu  2 , Il-Tae Jang  2
Affiliations
Case Reports

Infected Schmorl's node: a case report

Hyeun Sung Kim et al. BMC Musculoskelet Disord. .

Abstract

Background: Schmorls node (SN) are mostly asymptomatic and incidental findings on MRI. However, sometimes they present like acute onset low back pain or acute exacerbation of chronic back pain after minor trauma.

Case presentation: We present rare case of symptomatic infected SN in 67 years female patient presented with complains of low back pain radiating to right buttock. After initial conservative treatment failed subsequent imaging showed significant increase in size of lesion with focal signal changes in disc space gave suspicion of underlying secondary pathology. Patient operated for complete excision of lesion. Histopathological report was suggestive of pyogenic vertebral osteomyelitis. Patient improved well postoperatively.

Conclusion: Most of the time acute SN responds well to conservative treatment; however rapid deterioration of symptoms or persistent severe pain should give suspicion of underlying secondary pathology.

Keywords: Infected; MRI; Schmorl’s node; Symptomatic.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
plain radiograph AP (a) and lateral view (b) showing mild degenerative scoliosis CT scan saggital (c) and axial (d) section showing schmorls node at inferior end plate of L3 vertebra with end plate defect
Fig. 2
Fig. 2
Initial MRI (a) T2 weighted sagittal image and (b) T2 weighted axial view showings Schmorl’s node with iso to high signal intensity, (c) T1 weighted sagittal image and (d) T1 weighted axial image showing low signal intensity
Fig. 3
Fig. 3
Repeat MRI (a, b) T1 weighted sagittal image and (c) STIR image showing increased signal intensity in L3 vertebra with anterio-superior part of L4. b Follow-up T2 weighted images showing decreased signal intensity suggestive of extensive marrow oedema. Repeat CT scan saggital (f) and axial (g) section showing increase in size of osteolytic lesion
Fig. 4
Fig. 4
Post-operative 6 months radiograph: a AP view, b Lateral view, c 6 months follow-up MRI showing complete excision of lesion and complete resolution of osteolytic signal
Fig. 5
Fig. 5
Histopathology slide (a) 100 HPF and (b) 400 HPF showing inflammatory cells infiltration with acute granulation tissue suggestive of pyogenic vertebral osteomyelitis
See this image and copyright information in PMC

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