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Schmorl's nodes: current pathophysiological, diagnostic, and therapeutic paradigms

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Abstract

Schmorl's nodes were first described by the pathologist Christian Schmorl in 1927 as a herniation of the nucleus pulposus through the cartilaginous and bony endplate into the vertebral body. Although such lesions present most commonly as incidental findings in asymptomatic patients (or in patients with back or radicular pain due to other etiology), there have been several reports emphasizing the deleterious effects of the inflammatory response and endplate changes elicited by the herniation of for such reasons, Schmorl's nodes have been occasionally implicated in the etiology of chronic axial pain as well as in pathological osteoporotic fractures. In this article, a thorough literature review about the most relevant historical studies on Schmorl's nodes previously published is performed. Furthermore, the authors provide an overview about the recent advances in basic science research on the pathophysiology of such lesions, as well as on current diagnostic and therapeutic paradigms.

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Correspondence to Tobias A. Mattei.

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Comments

Hussam Metwali, Hannover, Germany

In this article, the author discussed the debate of the clinical/radiological significance of Schmorl's nodules. The authors performed a nice review of literature making this article a good reference for further reading in this topic. Although this article appears academically nice, its impact in clinical practice, according to our opinion, is limited. The debate is not solved. It would be better if the authors had added their own series and discussed their own finding.

It would be great if the authors use this knowledge for a future clinical study.

Noel I Perin, New York, USA

This is an interesting article researching a common finding on routine MRI studies, which may be relevant in patients with back pain symptoms. The pathophysiology of these lesions and their association with adjacent disc degeneration is an important observation. Patients presenting with back pain symptoms and large Schmorl's nodes with type 1 Modic changes may well be candidates for surgical treatment when conservative treatment measures fail. Additionally, osteoporotic patients with large Schmorl's nodes may benefit from early vertebroplasty to prevent fractures. The authors should be congratulated for this interesting paper on an entity thought of as an incidental finding on MRI studies and reminds us to observe these lesions more closely.

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Mattei, T.A., Rehman, A.A. Schmorl's nodes: current pathophysiological, diagnostic, and therapeutic paradigms. Neurosurg Rev 37, 39–46 (2014). https://doi.org/10.1007/s10143-013-0488-4

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  • DOI: https://doi.org/10.1007/s10143-013-0488-4

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