{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:37:18Z","timestamp":1760150238031,"version":"build-2065373602"},"reference-count":22,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2023,10,16]],"date-time":"2023-10-16T00:00:00Z","timestamp":1697414400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Schmorl\u2019s nodes (SNs), formed by the herniation of intervertebral discs into adjacent vertebral bodies, are generally asymptomatic and do not require treatment. However, certain types of SNs can cause intractable back pain. Case Presentation: A 63-year-old man presented to our hospital with back pain after a fall 1 month prior. Physical examination revealed back pain that worsened with movement and paraspinal tenderness. Magnetic resonance imaging (MRI) performed immediately after presentation revealed subacute to chronic compression fractures with SNs at the upper endplates of the 11th and 12th thoracic and 1st lumbar vertebrae. Pain (numeric rating scale (NRS), 7\u20138\/10) persisted despite 6 months of conservative treatment and MRI revealed increased signal intensity in T2-weighted images in the regions around the SNs. Based on these findings, an epidural nerve block was performed, and then repeated; however, no significant improvement was observed. Percutaneous vertebroplasty (PVP) was performed at the 11th and 12th thoracic and 1st lumbar vertebrae. Pain levels decreased substantially 1 week after PVP (NRS, 3\u20134\/10). Subsequent treatment with non-steroidal anti-inflammatory drugs (NSAIDs) and steroids for two weeks further reduced pain levels (NRS, 1\u20132\/10), following which steroid use was discontinued and NSAID use became intermittent. At the six-month follow-up, pain levels remained low and the patient reported an improvement in activity levels of 90% or more. Conclusions: This case report demonstrates that PVP safely and effectively improved symptoms in a patient with multiple SNs and intractable back pain. Nevertheless, further research, particularly large-scale randomized prospective studies, is necessary to validate the long-term efficacy and safety of this intervention.<\/jats:p>","DOI":"10.3390\/medicina59101839","type":"journal-article","created":{"date-parts":[[2023,10,16]],"date-time":"2023-10-16T10:06:36Z","timestamp":1697450796000},"page":"1839","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Percutaneous Vertebroplasty in a Patient with Chronic Back Pain Caused by Multiple Schmorl\u2019s Nodes: A Case Report"],"prefix":"10.3390","volume":"59","author":[{"given":"Hyung-Joon","family":"Park","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, 153 Gyeongchun Road, Guri 11923, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyun-Ji","family":"Jo","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, 148 Gurodong Road, Seoul 08308, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaeeun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, 148 Gurodong Road, Seoul 08308, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0260-9886","authenticated-orcid":false,"given":"Sang-Sik","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, 148 Gurodong Road, Seoul 08308, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1557-3832","authenticated-orcid":false,"given":"Chung-Hun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, 148 Gurodong Road, Seoul 08308, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2115","DOI":"10.1007\/s00586-012-2325-9","article-title":"Schmorl\u2019s nodes","volume":"21","author":"Kyere","year":"2012","journal-title":"Eur. Spine J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1302\/0301-620X.85B6.13555","article-title":"The pathogenesis of Schmorl\u2019s nodes","volume":"85","author":"Peng","year":"2003","journal-title":"J. Bone Joint. Surg Br."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1002\/art.22789","article-title":"Schmorl\u2019s nodes: Common, highly heritable, and related to lumbar disc disease","volume":"57","author":"Williams","year":"2007","journal-title":"Arthritis Rheum."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1186\/s13018-020-01873-6","article-title":"Percutaneous vertebroplasty (PVP) to treat a specialized type of endplate fractures around the Schmorl\u2019s node: A prospective study of 65 patients","volume":"15","author":"Zhang","year":"2020","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1007\/BF00298420","article-title":"Schmorl\u2019s nodes and low-back pain. Analysis of magnetic resonance imaging findings in symptomatic and asymptomatic individuals","volume":"4","author":"Takahashi","year":"1995","journal-title":"Eur. Spine J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1007\/s00270-005-0153-6","article-title":"Percutaneous vertebroplasty in painful schmorl nodes","volume":"29","author":"Masala","year":"2006","journal-title":"Cardiovasc. Intervent. Radiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1038\/sj.sc.3101506","article-title":"Painful Schmorl\u2019s node treated by lumbar interbody fusion","volume":"42","author":"Hasegawa","year":"2004","journal-title":"Spinal Cord"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"262","DOI":"10.3344\/kjp.2010.23.4.262","article-title":"Rami communicans nerve block for the treatment of symptomatic Schmorl\u2019s nodes\u2014A case report","volume":"23","author":"Jang","year":"2010","journal-title":"Korean J. Pain"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1007\/s00586-017-4996-8","article-title":"Painful Schmorl\u2019s nodes treated by discography and discoblock","volume":"27","author":"Liu","year":"2018","journal-title":"Eur. Spine J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"S45","DOI":"10.1097\/01.BRS.0000076898.37566.32","article-title":"Minimally invasive treatments of osteoporotic vertebral compression fractures","volume":"28","author":"Phillips","year":"2003","journal-title":"Spine"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1007\/s00256-005-0068-y","article-title":"Edematous Schmorl\u2019s nodes on thoracolumbar MR imaging: Characteristic patterns and changes over time","volume":"35","author":"Wu","year":"2006","journal-title":"Skeletal Radiol."},{"key":"ref_12","first-page":"1807","article-title":"Value of bone scan imaging in predicting pain relief from percutaneous vertebroplasty in osteoporotic vertebral fractures","volume":"21","author":"Maynard","year":"2000","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1097\/RLU.0b013e3181e9fb07","article-title":"Utility of bone scintigraphy to determine the appropriate vertebral augmentation levels","volume":"35","author":"Jordan","year":"2010","journal-title":"Clin. Nucl. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1016\/j.bjan.2017.07.007","article-title":"Radicular pain caused by Schmorl\u2019s node: A case report","volume":"68","author":"Kim","year":"2018","journal-title":"Braz. J. Anesthesiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1016\/j.mehy.2009.09.044","article-title":"Possible key role of the immune system in Schmorl\u2019s nodes","volume":"74","author":"Zhang","year":"2010","journal-title":"Med. Hypotheses"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1007\/s00234-019-02171-7","article-title":"Symptomatic Schmorl\u2019s nodes: Role of percutaneous vertebroplasty. Open study on 52 patients","volume":"61","author":"Amoretti","year":"2019","journal-title":"Neuroradiology"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Cai, K., Jiang, G., Lu, B., Zhang, K., and Luo, K. (2023). Bone cement distribution may significantly affect the efficacy of percutaneous vertebroplasty in treating symptomatic Schmorl\u2019s nodes. BMC Musculoskelet. Disord., 24.","DOI":"10.1186\/s12891-023-06575-8"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1007\/s10143-013-0488-4","article-title":"Schmorl\u2019s nodes: Current pathophysiological, diagnostic, and therapeutic paradigms","volume":"37","author":"Mattei","year":"2014","journal-title":"Neurosurg. Rev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"441","DOI":"10.14444\/7058","article-title":"Schmorl Node-A Cause of Acute Thoracic Pain: A Case Report and Pathophysiological Mechanism","volume":"14","author":"Hershkovich","year":"2020","journal-title":"Int. J. Spine Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"131","DOI":"10.4184\/asj.2013.7.2.131","article-title":"Acute Schmorl node in the dorsal spine: An unusual cause of a sudden onset of severe back pain in a young female","volume":"7","author":"Ohana","year":"2013","journal-title":"Asian Spine J."},{"key":"ref_21","first-page":"69","article-title":"Percutaneous Vertebroplasty for Symptomatic Schmorl\u2019s Nodes: 11 Cases with Long-term Follow-up and a Literature Review","volume":"20","author":"He","year":"2017","journal-title":"Pain Physician"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2879","DOI":"10.12659\/MSM.904802","article-title":"A Retrospective Study of Percutaneous Balloon Kyphoplasty for the Treatment of Symptomatic Schmorl\u2019s Nodes: 5-Year Results","volume":"23","author":"Huan","year":"2017","journal-title":"Med. Sci. Monit."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/10\/1839\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:07:50Z","timestamp":1760130470000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/10\/1839"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,16]]},"references-count":22,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,10]]}},"alternative-id":["medicina59101839"],"URL":"https:\/\/doi.org\/10.3390\/medicina59101839","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2023,10,16]]}}}