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Painful Schmorl’s nodes treated by discography and discoblock

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Abstract

Purpose

To determine the efficacy of discography and discoblock in the treatment of low back pain (LBP) associated with painful Schmorl’s nodes (SNs).

Methods

Between January 2010 and February 2015, 46 patients were studied who had LBP suspected to be secondary to SNs. There were 34 men and 12 women, and mean age was 54.2 years (range 42–68 years). All patients underwent provocation discography, and discoblock was given to positive patients (confirmed to have painful SNs). Visual analogue scores (VAS) and the Oswestry Disability Index (ODI) were evaluated at 4 h and 1, 3, 6, and 12 months post-operatively. MRI was also used to evaluate the SNs at 12 months.

Results

Discography was performed on a total of 60 discs without infection or other complications. Positive findings were found in 71.7% discs; 20.0% were negative, and 8.3% were indeterminate. Among the positive patients who underwent discoblock, 89.2% reported an improvement in their LBP, and none reported worsening symptoms. VAS and ODI scores decreased significantly after discoblock, and there were no significant differences between 4 h and 1, 3, 6, and 12 months post-operatively. In patients with painful SNs, the vertebral body bone marrow surrounding the SN was characterized by low T1 and high T2 signals on MRI. At 12 months, the node demonstrated either high T1 and T2 signals or low T1 and T2 signals. The SNs tended to remain stable in size over time.

Conclusions

Painful SNs refractory to medical or physical therapy should be an indication for treatment with discography and discoblock.

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Author notes

    Authors and Affiliations

    1. Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3, Qingchun Road East, Hangzhou, 310016, People’s Republic of China

      Junhui Liu, Lu Hao, Xuyang Zhang, Zhi Shan, Shengyun Li, Shunwu Fan & Fengdong Zhao

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    1. Junhui Liu
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    2. Lu Hao
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    3. Xuyang Zhang
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    4. Zhi Shan
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    5. Shengyun Li
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    6. Shunwu Fan
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    7. Fengdong Zhao
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    Corresponding author

    Correspondence to Fengdong Zhao.

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    Funding

    National Natural Science Foundation of China (Project No. 31270997) and Zhejiang Medical and Health Science and Technology project (Project No. 2016136915).

    Conflict of interest

    Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

    Additional information

    J. Liu and L. Hao contributed equally to this paper and should be considered co-first authors.

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    Liu, J., Hao, L., Zhang, X. et al. Painful Schmorl’s nodes treated by discography and discoblock. Eur Spine J 27, 13–18 (2018). https://doi.org/10.1007/s00586-017-4996-8

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    • DOI: https://doi.org/10.1007/s00586-017-4996-8

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