Pediatric Schmorl Nodes

• Etiology:
  — May be post traumatic
  — Is intravertebral disc herniation caused by protrusion of the cartilage of the intervertebral disc through the vertebral body endplate into adjacent vertebra which may contact the marrow of the vertebra thus leading to inflammation
• Imaging Radiograph:
  — Small nodular lucent lesions involving inferior endplate of lower thoracic and lumbar vertebral bodies
  — Involvement of both inferior and superior endplates of vertebral bodies is not uncommon
  — Sclerotic margin may be present
• Imaging CT:
  — Best seen on CT as small nodular lucent lesions involving most commonly inferior endplate of lower thoracic and lumbar vertebral bodies
  — Involvement of both inferior and superior endplates of vertebral bodies is not uncommon
  — Sclerotic margin may be present
• Imaging MRI:
  — Best seen on sagittal sequences
  — Have same signal characteristics as adjacent disc with thin rim of sclerosis at margin
  — Acute Schmorl nodes can appear more aggressive with surrounding bone marrow edema and peripheral enhancement
• DDX:
  — Osteomyelitis discitis – will be less focal and have fever and epidural or prevertebral phlegmonous changes
  — Metastases
• Complications: Scheuermann disease
• Treatment: None
• Clinical: Usually asymptomatic

Radiology Cases of Schmorl Nodes