What is it really?
The vertebral body is covered above and below with a thin endplate, to which the intervertebral disc is adjacent. If there is a weakened area in this plate - due to developmental characteristics, microtrauma or decreased bone density - part of the nucleus pulposus of the disc is pressed into the vertebra and forms a characteristic depression. In the photo it looks like a notch with clear edges. The nerve structures remain aside, so this finding does not cause any radicular pain or numbness.
- Pressure of the disc into the vertebral body
- Direction upward or downward, not into the spinal canal
- Nerve roots are not compressed
- Most often in the thoracic and upper lumbar regions
- Can be single or multiple
- Often exist from adolescence
Why do they appear
The most common situation is a period of rapid growth in adolescence, when the bone has not yet gained strength, and the loads are already adult. Here the nodes are often combined with Scheuermann's disease and increased thoracic kyphosis. In adults, the cause is heavy axial loads, jumping, falling on the legs or buttocks. A separate group includes conditions in which the bone is weakened: osteoporosis, long-term use of glucocorticoids, some metabolic and tumor diseases. In the latter case, it is not the node itself that is important, but the reason for the fragility of the bone.
- Rapid growth during adolescence
- Scheuermann's disease
- Hereditary structural features
- Heavy physical labor and power loads with axial compression
- Injuries, falls, jumps from heights
- Osteoporosis and decreased bone density
- Long-term use of glucocorticoids
Are there symptoms?
In the vast majority of cases, the person does not feel anything, and the nodes become an unexpected discovery. Sometimes a fresh impression due to injury or during a period of active growth is accompanied by local aching pain, which intensifies with exercise and decreases with rest. However, if your back hurts regularly, and an MRI reveals only Schmorl’s hernias, it is wrong to explain the pain with them: the muscles, joints of the spine, poor posture or overload are much more often to blame. The doctor’s task is to find the real source of pain, and not to treat the conclusion of the image.
- Usually no complaints at all
- Possible local pain with fresh pressure
- No numbness, weakness or radicular pain
- There is no connection with disruption of internal organs
- Multiple nodes may accompany slouching in a teenager
- Pain almost always has another cause
Examination: what and why
The nodes are clearly visible on a regular X-ray, and an MRI additionally shows whether the depression is fresh and whether there is swelling of the bone tissue. The point of the examination is not to count nodes, but to exclude significant causes of pain and assess the general condition of the spine. In a teenager with severe stoop, the degree of kyphosis is assessed. In a person over 50 years of age, especially in a woman after menopause, multiple nodes and deformities of the vertebrae are a reason to discuss screening for osteoporosis. If the picture is unusual, the doctor excludes inflammatory and tumor processes.
- X-ray of the spine in two projections
- MRI for pain, injury and to assess the severity of changes
- Assessment of kyphosis angle in adolescents
- Densitometry for suspected osteoporosis
- Blood tests for suspected inflammation
- Examination by a neurologist to find the true cause of pain
What to do and what loads you can
If there are no complaints, treatment is not needed: the nodes do not grow towards the nerves, do not turn into ordinary hernias and do not require surgery. It is reasonable to maintain the muscle corset, maintain mobility of the spine and monitor technique during training. It is worth limiting axial load with a large weight on the shoulders, jumping and jerking heavy lifting, especially for adolescents during the growth period. For pain, physical therapy and, if necessary, a short course of painkillers as prescribed by the doctor are selected. Separately, they deal with the prevention of osteoporosis, if indicated.
- Regular exercises for the back and abdominal muscles
- Swimming and walking as basic exercise
- Avoid squats and presses with heavy weight on your shoulders
- Avoid lifting weights with a jerk and a round back
- Posture control in adolescents
- Adequate intake of calcium and vitamin D
- Screening for osteoporosis according to indications