Disclosures: Nivin Porwal, DO: Nothing to disclose

Case Description: During the second semester of his freshman year, this 18-year-old college student developed significant thoracolumbar back pain without history of trauma. The pain did not radiate into his legs. He denied numbness, tingling, weakness, or bowel or bladder issues. The pain was exacerbated by active lumbar flexion and extension. He had difficulty carrying his heavy book-bag and getting down from his lofted bed. His past medical history was unremarkable. His physical examination revealed discomfort with lumbar spine range of motion in all planes, worse with extension. Strength, reflexes, and sensation were within normal limits. Physical therapy and home exercises did not provide any relief. Celecoxib and Tramadol only offered minimal symptomatic relief. Lumbar spine x-rays showed a Schmorl’s node at T12. The treating physiatrist did not make much of this finding as asymptomatic Schmorl’s nodes can be seen between 38-75 % of the population and are the most common non-disc abnormality seen on imaging.

Setting: Outpatient Physical Medicine and Rehabilitation Clinic

Patient: 18-year-old male college student with acute back pain

Assessment/Results: A subsequent MRI of the lumbar spine showed the same Schmorl’s node with surrounding edema. The patient was treated with limitation of activities and his pain resolved in 4 months. A follow up MRI showed the Schmorl’s node without edema.

Discussion: It is not unusual to see Schmorl’s nodes on MRI in a patient with back pain, but the edema surrounding it suggests acute bony pathology is the etiology of the symptoms.

Conclusion: This case illustrates an unusual cause of back pain, an acute, symptomatic Schmorl’s node, as revealed by the surrounding edema in a young patient with low back pain and should be considered during the evaluation of patients with x-ray findings of Schmorl’s nodes without other abnormalities.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-symptomatic-schmorls-node-in-a-young-man-an-unusual-cause-of-back-pain-in-a-teen-a-case-report/