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Abstract
Objectives
We retrospectively evaluated the clinical efficacy of postganglionic nerve block in symptomatic Schmorl nodules (SNs).
Summary of Literature Review
SNs are common lesions that are often asymptomatic. In certain cases, SNs have been reported to cause severe axial back pain, thereby considerably impacting patients’ quality of life. No consensus currently exists on the treatment of symptomatic SNs.
Materials and Methods
From October 2015 to October 2017, a total of 21 patients with symptomatic SNs diagnosed by magnetic resonance imaging (MRI) that did not respond to conservative treatment after 4 weeks were included in the study. All patients received postganglionic nerve block. We evaluated effective pain relief (improvement of back pain of more than 50% compared with before the intervention) and functional improvements, assessed by visual analogue scale (VAS) and Oswestry Disability Index scores obtained at 4 hours, 4 weeks, 8 weeks, 3 months, and 6 months after the procedure.
Results
Symptomatic SNs were more common at the L2-3 level, and the lower end plate was more commonly involved than the upper end plate. Eighteen of the 21 patients (85.7%) showed effective pain relief, and no deterioration was observed within the follow-up period. Throughout the follow-up period, the VAS remained significantly improved compared to before the procedure (p<0.05). Complications were not reported in any cases.
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Fig. 1.
Radiologic findings of symptomatic Schmorl nodes (SNs). On plain radiographs (A, B), L2 lower endplate disruptions were found. Magnetic resonance imaging (MRI) revealed a Schmorl node of the L2 vertebral body with adjacent bone marrow, characterized by a low-inten-sity T1-weighted image (C) and a high-intensity T2-weighted image (D) on MRI, which is the same signal as that of the adjacent intervertebral disc. Curved dotted line: margin of the Schmorl node.
Fig. 2.
Entry point of postganglionic spinal nerve block.(A) Entry point in 25° oblique images, (B) Diagram, Black line: lateral transverse process line, Black dotted line: lateral pedicular line, Black double dotted line: medial pedicular line, White curved line: exiting nerve root, Gray triangle area: safe triangle for conventional transforaminal approach, Black cross: entry point of postganglionic spinal nerve block, Black arrow: direction of block.
Fig. 3.
Contrast spreading pattern of postganglionic spinal nerve block. (A) The postganglionic epidurographic pattern when 1 mL of contrast was injected into the extraforaminal space on the standard anteroposterior view. (B) The postganglionic epidurographic pattern when 1 mL of contrast was injected into the extraforaminal space on the standard lateral view. (C) The postganglionic epidurographic pattern when 1 mL of contrast was injected into the extraforaminal space on the left side (25° oblique view). (D) The contrast spread pattern when the injectates were administered into the extraforaminal space on the standard anteroposterior view.
Table 1.
Demographic Data
| Age (mean±STD) | Gender (M/F) | BMI (㎏/㎡) | Level | Region | ||||
|---|---|---|---|---|---|---|---|---|
| L1/2 | L2/3 | L3/4 | L4/5 | Inferior endplate | Superior endplate | |||
| 48.2±6.2 | 15/6 | 26.5±4.6 | 6 | 9 | 4 | 2 | 13 | 8 |
Table 2.
Pre-intervention and post-intervention comparison of VAS and ODI for patient who had symptomatic Schmorl's node and underwent the post-gagnlionic spinal nerve block.
| Pre-Intervention | Post-4 hours | 4weeks | 2months | 3months | 6months | |
|---|---|---|---|---|---|---|
| VAS | 6.8±2.3 | 2.3±0.8 | 2.2±0.3 | 2.1±0.4 | 2.3±0.3 | 2.3±0.4 |
| ODI | 62.5±10.9 | ─ | 24.4±2.1 | 25.2±2.8 | 24.8±3.1 | 24.6±2.9 |
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