A Schmorl’s node appears on a great many scans, including in people with no symptoms at all. Here is how to judge whether yours is relevant.
Has your spinal MRI report mentioned a Schmorl’s node? It is an unfamiliar term to most patients, and an unsettling thing to find in a report. Let me explain what it is, when it matters, and what can be done about it.
The anatomy first
Your spine is a stack of bones called vertebrae, with dark cushions between them called discs. Within the spinal column runs a canal containing and protecting the spinal cord and the nerves.
When we talk about a disc slipping or leaking, we usually mean a herniation, where disc material bulges backwards into the spinal canal where the nerves are.
A Schmorl’s node is different. Here the disc breaks or leaks into the adjacent bone instead, upwards or downwards into the vertebra rather than backwards towards the nerves.
It is extremely common
Reports suggest Schmorl’s nodes are seen in up to around 70% of people, which necessarily includes a great many with no spinal problems whatsoever.
In the majority of cases, then, it is a completely incidental finding.
Why they form
There are several reasons:
- Hereditary, probably the commonest. Small dents in the end plate adjacent to the disc simply run in families, and those dents fill with disc material.
- Degenerative change, where small defects or cracks form in the bone and disc material leaks in.
- Osteoporosis, where thinning, brittle bone can crack and allow disc material into it. This usually heals.
- Heavy lifting. In my own practice I have seen this in weightlifters performing deadlifts with considerable weight, where excessive downward force causes the end plate to crack under pressure.
How we tell an incidental node from a relevant one
This is where reading the scan carefully earns its keep.
Take a patient with a very subtle Schmorl’s node, just slight irregularity of the end plate with a little disc material leaking in. On its own that tells us little. But a STIR sequence, a particular MRI setting in which water or fluid within bone glows brightly, shows whether there is inflammation around the node.
Where that inflammation is present, and where the clinical history and examination fit, the node is likely to be the source of the patient’s pain. Compare that with a scan where the bone surrounding the node looks entirely normal and uniform, and the picture is quite different.
There is one further clue: incidental Schmorl’s nodes tend to sit higher up the spine, somewhere in the middle region of the back.
Treatment, if it is relevant
If you are a keen lifter. Deadlifts and barbell back squats load the spine heavily. The approach is a short rest, then adapting the exercise and gradually reintroducing load. The physiotherapists I work with typically advise switching to single leg exercises after a week or two of rest. This gives the same muscle groups a comparable load while the spine itself takes considerably less, and you then step back into your normal routine gradually.
If you are not a heavy lifter and the problem keeps recurring with inflammatory changes still visible, it is worth examining your bone quality. A bone density scan will show any osteopenia or osteoporosis, where weakened bone allows these fractures to occur without much force at all.
If conservative measures fail. A 2017 review looked at patients with Schmorl’s nodes and adjacent inflammatory changes who underwent vertebroplasty, where cement is injected into the bone above and below the affected disc to reinforce it. The results were promising, with significant improvement in pain.
There is also a useful diagnostic step available. An injection around the nerve supplying these vertebral bodies can be performed as a test. If the pain is suppressed, even temporarily, that helps confirm the diagnosis.
Why the caution matters
It comes back to that 70% figure. Because Schmorl’s nodes are so common, we must be thoroughly satisfied that yours is genuinely the source of your pain before treating it as such.
The key takeaway
If you have struggled with back pain for some time and your MRI shows a Schmorl’s node, statistically it is unlikely to be the cause.
I cannot emphasise enough the importance of a good history and clinical examination, tied carefully to the MRI findings, with the scan examined closely enough to be sure.
