Disclosures: Barent Bradt, DO: No financial relationships or conflicts of interest

Case Diagnosis: Schmorl node causing L5 burst fraction during conservative treatment.

Case Description or Program Description: A 42-year-old male with low back injury. The patient was initially treated with oral steroids, muscle relaxers, and physical therapy but pain persisted. A lumbar MRI revealed a Schmorl node at the right L5 superior endplate and T1 hypointense signal consistent with vertebral body edema. The patient continued with conservative therapy; patient had traction exercise performed and subsequently sat up and developed acute worsening low back pain. Repeat MRI demonstrated an acute L5 burst fracture with 70% height loss with the right pedicle displaced abutting the L5 nerve root. Surgical intervention was not recommended. Following several months of therapy, the patient eventually improved.

Setting: Rehabilitation Institute of Michigan

Assessment/Results: Schmorl node L5 compression fracture

Discussion (relevance): Schmorl Nodes (SN) develop due to weakening of vertebral endplates from acute, chronic or embryogenic processes. They can be asymptomatic and SN can be an incidental finding. The gold standard for diagnosis is MRI. When SNs presents with lower back pain, it is likely due to herniation of the nucleus pulposus into the vertebral body leading to edema and inflammation. (1) Conservative treatments include; pain medications, exercise, weight loss and physical therapy. Currently, if conservative treatment fails, interventions including spinal fusion, nerve blocks, and vertebroplasty can be done. (1) A study with 14 patients with SNs, MRI’s revealed edema of the vertebral body and 6 of these patients showed a compression fracture of at least one additional level. (2) This highlights the possible instability a SN can cause.

Conclusions: Schmorl nodes are often found as incidental findings. In this case, the patient was a healthy 42-year-old male who developed a compression fracture secondary to a SN causing vertebral body instability while undergoing conservative therapy. Based on this case, SN causing pathology in the vertebral body should be monitored.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/compression-fracture-secondary-to-conservative-treatment-of-schmorl-node-a-case-report/