European Spine Journal

, Volume 27, Issue 1, pp 13–18 | Cite as

Painful Schmorl’s nodes treated by discography and discoblock

  • Junhui Liu
  • Lu Hao
  • Xuyang Zhang
  • Zhi Shan
  • Shengyun Li
  • Shunwu Fan
  • Fengdong ZhaoEmail author
Original Article



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


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.


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.


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


Back pain Painful Schmorl’s node Discography Discoblock 


Compliance with ethical standards


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.


  1. 1.
    Schmorl G (1927) Uber die an den wirbelbandscheiben vorkommenden ausdehnungs—und zerreisungsvorgange und die dadurch an ihnen und der wirbelspongiosa hervorgerufenen veranderungen. Verh Dtsch Path Ges 22:250Google Scholar
  2. 2.
    Resnick D, Niwayama G (1978) Intravertebral disk herniation cartilaginous (Schmorl’s) nodes. Radiology 126:57–65CrossRefPubMedGoogle Scholar
  3. 3.
    Hamanishi C, Kawabata T, Yosii T, Tanaka S (1994) Schmorl’s nodes on magnetic resonance imaging. Their incidence and clinical relevance. Spine 19:450–453CrossRefPubMedGoogle Scholar
  4. 4.
    Jensen MC, Brant-Zawadski MN, Obuchowski N, Modic MT, Malkasian D, Ross JS (1994) Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 331:69–73CrossRefPubMedGoogle Scholar
  5. 5.
    Coventry MB, Ghormley RK, Kernohan JW (1945) The intervertebral disc: its microscopic anatomy and pathology. Part I. Anatomy, development, and physiology. J Bone Jnt Surg Am 27:105–112Google Scholar
  6. 6.
    Hilton RC, Ball J, Benn RT (1976) Vertebral end-plate lesions (Schmorl’s nodes) in the dorsolumbar spine. Ann Rheum Dis 35:127–132CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Keyes DC, Compere EL (1932) The normal and pathological physiology of the nucleus pulposus of the intervertebral disc: an anatomical, clinical, and experimental study. J Bone Jnt Surg Am 14:897–938Google Scholar
  8. 8.
    Fahey V, Opeskin K, Silberstein M, Anderson R, Briggs C (1998) The pathogenesis of Schmorl’s nodes in relation to acute trauma. An autopsy study. Spine (Phila Pa 1976) 23:2272–2275CrossRefGoogle Scholar
  9. 9.
    Takahashi K, Takata K (1994) Large painful Schmorl’s node: a case report. J Spinal Disord 7(1):77–81CrossRefPubMedGoogle Scholar
  10. 10.
    Hasegawa K, Ogose A, Morita T et al (2004) Painful Schmorl’s node treated by lumbar interbody fusion. Spinal Cord 42(2):124–128CrossRefPubMedGoogle Scholar
  11. 11.
    Grivé E, Rovira A, Capellades J, Rivas A, Pedraza S (1999) Radiographic findings in two cases of acute Schmorl’s nodes. Am J Neuroradiol 20:1717–1721PubMedGoogle Scholar
  12. 12.
    Takahashi K, Miyakazi T, Ohnari H, Takino T, Tomita K (1995) Schmorl’s nodes and low back pain. Analysis of MRI findingsin symptomatic and asymptomatic individuals. Eur Spine J 4:56–59CrossRefPubMedGoogle Scholar
  13. 13.
    Masala S, Pipitone V, Tomassini M, Massari F, Romagnoli A, Simonetti G (2006) Percutaneous vertebroplasty in painful schmorl nodes. Cardiovasc Intervent Radiol 29(1):97–101CrossRefPubMedGoogle Scholar
  14. 14.
    Peng B, Chen J, Kuang Z, Li D, Pang X, Zhang X (2009) Diagnosis and surgical treatment of back pain originating from endplate. Eur Spine J 18:1035–1040CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Jang JS, Kwon HK, Lee JJ, Hwang SM, Lim SY (2010) Rami communicans nerve block for the treatment of symptomatic Schmorl’s nodes—a case report. Korean J Pain 23(4):262–265CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Ohtori S, Kinoshita T, Yamashita M et al (2009) Results of surgery for discogenic low back pain: a randomized study using discography versus discoblock for diagnosis. Spine (Phila Pa 1976) 34(13):1345–1348CrossRefGoogle Scholar
  17. 17.
    Bogduk N (1988) Acute back pain: what is the lesion? In: Proceedings of a symposium on Acute Back Pain, 2nd European Congress on back pain, Montreux, pp 6–16Google Scholar
  18. 18.
    Luoma K, Vehmas T, Kerttula L, Grönblad M, Rinne E (2016) Chronic low back pain in relation to Modic changes, bony endplate lesions, and disc degeneration in a prospective MRI study. Eur Spine J 25(9):2873–2881CrossRefPubMedGoogle Scholar
  19. 19.
    Teraguchi M, Yoshimura N, Hashizume H, Muraki S, Yamada H, Oka H, Minamide A, Nakagawa H, Ishimoto Y, Nagata K, Kagotani R, Tanaka S, Kawaguchi H, Nakamura K, Akune T, Yoshida M (2015) The association of combination of disc degeneration, end plate signal change, and Schmorl node with low back pain in a large population study: the Wakayama Spine Study. Spine J 15(4):622–628CrossRefPubMedGoogle Scholar
  20. 20.
    Park P, Tran NK, Gala VC, Hoff JT, Quint DJ (2007) The radiographic evolution of a Schmorl’s node. Br J Neurosurg 21(2):224–227CrossRefPubMedGoogle Scholar
  21. 21.
    Simmons JW, Emery SF, McMillin JN, Landa D, Kimmich SJ (1991) Awake discography. A comparison study with magnetic resonance imaging. Spine 16:S216–S221CrossRefPubMedGoogle Scholar
  22. 22.
    Chen JY, Ding Y, Lu RY et al (2011) Correlation between MR imaging and discography with provocative concordant pain in patients with low back pain. Clin J Pain 27:125–130CrossRefPubMedGoogle Scholar
  23. 23.
    Derby R, Kim BJ, Lee SH, Chen Y, Seo KS, Aprill C (2005) Comparison of discographic findings in asymptomatic subject discs and the negative discs of chronic LBP patients: can discography distinguish asymptomatic discs among morphologically abnormal discs? Spine J 5:389–394CrossRefPubMedGoogle Scholar
  24. 24.
    Lim CH, Jee WH, Son BC, Kim DH, Ha KY, Park CK (2005) Discogenic lumbar pain: association with MR imaging and CT discography. Eur J Radiol 54:431–437CrossRefPubMedGoogle Scholar
  25. 25.
    Bobechko WP, Hirsch C (1965) Auto-immune response to nucleus pulposus in the rabbit. J Bone Joint Surg Br 47:574–580PubMedGoogle Scholar
  26. 26.
    Takatalo J, Karppinen J, Niinimaki J et al (2012) Association of Modic changes, Schmorl’s nodes, spondylolytic defects, high-intensity zone lesions, disc herniations, and radial tears with low back symptom severity among young Finnish adults. Spine (Phila Pa 1976) 37:1231–1239CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Junhui Liu
    • 1
  • Lu Hao
    • 1
  • Xuyang Zhang
    • 1
  • Zhi Shan
    • 1
  • Shengyun Li
    • 1
  • Shunwu Fan
    • 1
  • Fengdong Zhao
    • 1
    Email author
  1. 1.Department of Orthopaedics, Sir Run Run Shaw Hospital, School of MedicineZhejiang UniversityHangzhouPeople’s Republic of China

Personalised recommendations