Schmorl’s nodes distribution in the human spine and its possible etiology

Abstract

Although Schmorl’s nodes (SNs) are a common phenomenon in the normal adult population, their prevalence is controversial and etiology still debatable. The objective was to establish the spatial distribution of SNs along the spine in order to reveal its pathophysiology. In this study, we examined 240 human skeleton spines (T4-L5) (from the Hamann–Todd Osteological Collection) for the presence and location of SNs. To determine the exact position of SNs, each vertebral body surface was divided into 13 zones and 3 areas (anterior, middle, posterior). Our results show that SNs appeared more frequently in the T7-L1 region. The total number of SNs found in our sample was 511: 193 (37.7%) were located on the superior surface and 318 (62.3%) on the inferior surface of the vertebral body. SNs were more commonly found in the middle part of the vertebral body (63.7%). No association was found between the SNs location along the spine and gender, ethnicity and age. This study suggests that the frequency distribution of SNs varies with vertebra location and surface. The results do not lend support to the traumatic or disease explanation of the phenomenon. SNs occurrences are probably associated with the vertebra development process during early life, the nucleus pulposus pressing the weakest part of the end plate in addition to the various strains on the vertebrae and the intervertebral disc along the spine during spinal movements (especially torsional movements).

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

References

  1. 1.

    McFadden KD, Taylor JR (1989) End-plate lesions of the lumbar spine. Spine 14:867–869

    Article  CAS  PubMed  Google Scholar 

  2. 2.

    Resnick D, Niwayama G (1978) Intervertebral disc herniations: cartilaginous (Schmorl’s) nodes. Radiology 126:57–65

    CAS  PubMed  Google 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 19:450–453

    Article  CAS  PubMed  Google Scholar 

  4. 4.

    Wu HT, Morrison WB, Schweitzer ME (2006) Edematous Schmorl’s nodes on thoracolumbar MR imaging: characteristic patterns and changes over time. Skeletal Radiol 35:212–219

    Article  PubMed  Google Scholar 

  5. 5.

    Stäbler A, Bellan M, Weiss M, Gärtner C, Brossmann J, Reiser MF (1997) MR imaging of enhancing intraosseous disk herniation (Schmorl’s nodes). Am J Roentgenol 168:933–938

    Google Scholar 

  6. 6.

    Faccia KJ, Williams RC (2008) Schmorl’s nodes: clinical significance and implications for the bioarcheological record. Int J Osteoarchaeol 18:28–44

    Article  Google Scholar 

  7. 7.

    Hilton RC, Ball J, Benn RT (1976) Vertebral end-plate lesions (Schmorl’s nodes) in the dorsolumbar spine. Ann Rheum Dis 35:127–132

    Article  CAS  PubMed  Google Scholar 

  8. 8.

    Saluja G, Fitzpatrick K, Bruce M, Cross J (1986) Schmorl’s nodes (intervertebral herniations of intervertebral disc tissue) in two historic British populations. J Anat 145:87–96

    CAS  PubMed  Google Scholar 

  9. 9.

    Landis JR, Koch GG (1977) The measurements of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  PubMed  Google Scholar 

  10. 10.

    Schmorl G, Junghanns H (1971) The Human Spine in Health and Disease (2nd American edition translated and edited by Besemann EF). Grune and Stratton, New York

    Google Scholar 

  11. 11.

    Hansson T, Roos B (1983) The amount of bone mineral and Schmorl’s nodes in lumbar vertebrae. Spine 8:266–271

    Article  CAS  PubMed  Google Scholar 

  12. 12.

    Frymoyer JW, Newberg A, Pope MH, Wilder DG, Clements J, MacPherson B (1984) Spine radiographs in patients with low-back pain. An epidemiological study in men. J Bone Joint Surg Am 66:1048–1055

    CAS  PubMed  Google Scholar 

  13. 13.

    Dar G, Peleg S, Masharawi M, Steinberg N, May H, Hershkovitz I (2009) Demographical aspects of Schmorl’s nodes—a skeletal study. Spine 34:E312–E315

    Article  PubMed  Google Scholar 

  14. 14.

    Pfirrmann CW, Resnick D (2001) Schmorl nodes of the thoracic and lumbar spine: radiographic-pathologic study of prevalence, characterization, and correlation with degenerative changes of 1, 650 spinal levels in 100 cadavers. Radiology 219:368–374

    CAS  PubMed  Google Scholar 

  15. 15.

    Williams FM, Manek NJ, Sambrook PN, Spector TD, Macgregor AJ (2007) Schmorl’s nodes: common, highly heritable, and related to lumbar disc disease. Arthritis Rheum 57:855–860

    Article  CAS  PubMed  Google Scholar 

  16. 16.

    Owsley DW, Orser CE Jr, Mann RW, Moore-Jansen PH, Montgomery RL (1987) Demography and pathology of an urban slave population from New Orleans. Am J Phys Anthropol 74:185–197

    Article  CAS  PubMed  Google Scholar 

  17. 17.

    Edwards WT, Zheng Y, Ferrara LA, Yuan HA (2001) Structural features and thickness of the vertebral cortex in the thoracolumbar spine. Spine 26:218–225

    Article  CAS  PubMed  Google Scholar 

  18. 18.

    Kapandji AI (2008) The Physiology of the Joints. vol III. The vertebral column, pelvic girdle and head, 6th edn. Churchill Livingstone, New York

  19. 19.

    Duan Y, Seeman E, Turner CH (2001) The biomechanical basis of vertebral body fragility in men and women. J Bone Miner Res 16:2276–2283

    Article  CAS  PubMed  Google Scholar 

  20. 20.

    Cvijetić S, McCloskey E, Korsić M (2000) Vertebral osteophytosis and vertebral deformities in an elderly population sample. Wien Klin Wochenschr 112(9):407–412

    PubMed  Google Scholar 

  21. 21.

    Gray H (1995) Gray’s anatomy, 38th edn. Churchill Livingstone, New York

    Google Scholar 

  22. 22.

    Moore K, Persuad T (2003) The developing human: clinically oriented embryology, 7th edn. WB Saunders, Philadelphia

  23. 23.

    Hongo M, Abe E, Shimada Y, Murai H, Ishikawa N, Sato K (1994) Surface strain distribution on thoracic and lumbar vertebrae under axial compression. The role in burst fractures. Spine 24:1197–1202

    Article  Google Scholar 

  24. 24.

    Grant JP, Oxland TR, Dvorak MF (2001) Mapping the structural properties of the lumbosacral vertebral endplates. Spine 26:889–896

    Article  CAS  PubMed  Google Scholar 

  25. 25.

    Gracovetsky S, Farfan H (1986) The optimum spine. Spine 11:543–573

    Article  CAS  PubMed  Google Scholar 

  26. 26.

    Gregersen GG, Lucas DB (1967) An in vivo study of the axial rotation of the human thoracolumbar spine. J Bone Joint Surg Am 49:247–262

    CAS  PubMed  Google Scholar 

  27. 27.

    Tribus CB (1998) Scheuermann’s kyphosis in adolescents and adults: diagnosis and management. J Am Acad Orthop Surg 6:36–43

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The author thanks Prof. Bruce Latimer, Mr. Lyman Jellema from the Cleveland Museum of Natural History, Cleveland, Ohio, for their support and assistance in using the invaluable Hamann-Todd osteological collection; to Mrs. Phyllis Curchack Kornspan for her editorial services; The Dan David Foundation, The Tassia and Dr. Joseph Meychan Chair of History and Philosophy of Medicine, and the Israel Science Foundation for their financial support.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Gali Dar.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Dar, G., Masharawi, Y., Peleg, S. et al. Schmorl’s nodes distribution in the human spine and its possible etiology. Eur Spine J 19, 670–675 (2010). https://doi.org/10.1007/s00586-009-1238-8

Download citation

Keywords

  • Spine
  • Spinal diseases
  • Intervertebral disc
  • Spine pathology
  • Disc herniation