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Case report
peer-reviewed

A Case of Persistent Low Back Pain in a Young Female Caused by a Trauma-Induced Schmorl’s Node in the Lumbar Spine Five Vertebra



Abstract

Physicians are often faced with managing difficult conditions such as chronic lower back pain. Intervertebral disk herniation typically occurs horizontally, leading to impingement of the spinal cord which can potentially cause radicular symptoms or other spinal cord pathologies; however, disk herniations can also occur vertically and extend through the endplate of an adjacent cranial or caudal vertebra: a phenomenon known as a Schmorl’s node. Although Schmorl’s nodes can be seen in many asymptomatic individuals, they can be a cause of degenerative disk disease and low back pain. An 18-year-old female with a history of trauma presented to urgent care with increasing lower back pain for the past six weeks. Four months prior, she was struck by a motor vehicle while riding her bicycle, and she had residual back pain since then. Plain radiography at the time of the accident showed no acute abnormalities. She had no other associated symptoms. On presentation, her vital signs were within normal limits, and her physical examination was largely unremarkable except for point tenderness along the lumbar (L4-L5) region of the spine. A complete blood count showed no leukocytosis and plain radiography of the lumbosacral spine showed a Schmorl’s node in the inferior endplate of L5. The patient was diagnosed with a trauma-induced Schmorl’s node and was treated with physical therapy, ice packs, and non-steroidal anti-inflammatory drugs. Her symptoms improved over the next several months. For patients with a history of axial load trauma and persistent back pain, clinicians should consider the possibility of a trauma-induced Schmorl’s node. Plain radiography or magnetic resonance imaging can help with the diagnosis and guide further management.



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Case report
peer-reviewed

A Case of Persistent Low Back Pain in a Young Female Caused by a Trauma-Induced Schmorl’s Node in the Lumbar Spine Five Vertebra


Author Information

Kurt M. Mohty Corresponding Author

College of Medicine, University of Arizona

Divneet Mandair

College of Medicine, University of Arizona

Brent Munroe

Department of Orthopaedic Surgery, University of Arizona

Deborah Baldemor

Department of Family Medicine, University of Arizona


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: The authors have declared that no conflicts of interest exist.

Acknowledgements

There was no funding source used for the production of this manuscript


Case report
peer-reviewed

A Case of Persistent Low Back Pain in a Young Female Caused by a Trauma-Induced Schmorl’s Node in the Lumbar Spine Five Vertebra


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Case report
peer-reviewed

A Case of Persistent Low Back Pain in a Young Female Caused by a Trauma-Induced Schmorl’s Node in the Lumbar Spine Five Vertebra

  • Author Information
    Kurt M. Mohty Corresponding Author

    College of Medicine, University of Arizona

    Divneet Mandair

    College of Medicine, University of Arizona

    Brent Munroe

    Department of Orthopaedic Surgery, University of Arizona

    Deborah Baldemor

    Department of Family Medicine, University of Arizona


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements

    There was no funding source used for the production of this manuscript


    Article Information

    Published: July 21, 2017

    DOI

    10.7759/cureus.1502

    Cite this article as:

    Mohty K M, Mandair D, Munroe B, et al. (July 21, 2017) A Case of Persistent Low Back Pain in a Young Female Caused by a Trauma-Induced Schmorl’s Node in the Lumbar Spine Five Vertebra. Cureus 9(7): e1502. doi:10.7759/cureus.1502

    Publication history

    Received by Cureus: June 15, 2017
    Peer review began: July 06, 2017
    Peer review concluded: July 15, 2017
    Published: July 21, 2017

    Copyright

    © Copyright 2017
    Mohty et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Physicians are often faced with managing difficult conditions such as chronic lower back pain. Intervertebral disk herniation typically occurs horizontally, leading to impingement of the spinal cord which can potentially cause radicular symptoms or other spinal cord pathologies; however, disk herniations can also occur vertically and extend through the endplate of an adjacent cranial or caudal vertebra: a phenomenon known as a Schmorl’s node. Although Schmorl’s nodes can be seen in many asymptomatic individuals, they can be a cause of degenerative disk disease and low back pain. An 18-year-old female with a history of trauma presented to urgent care with increasing lower back pain for the past six weeks. Four months prior, she was struck by a motor vehicle while riding her bicycle, and she had residual back pain since then. Plain radiography at the time of the accident showed no acute abnormalities. She had no other associated symptoms. On presentation, her vital signs were within normal limits, and her physical examination was largely unremarkable except for point tenderness along the lumbar (L4-L5) region of the spine. A complete blood count showed no leukocytosis and plain radiography of the lumbosacral spine showed a Schmorl’s node in the inferior endplate of L5. The patient was diagnosed with a trauma-induced Schmorl’s node and was treated with physical therapy, ice packs, and non-steroidal anti-inflammatory drugs. Her symptoms improved over the next several months. For patients with a history of axial load trauma and persistent back pain, clinicians should consider the possibility of a trauma-induced Schmorl’s node. Plain radiography or magnetic resonance imaging can help with the diagnosis and guide further management.



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Kurt M. Mohty, Medical Student

College of Medicine, University of Arizona

For correspondence:
kmohty10@email.arizona.edu

Divneet Mandair

College of Medicine, University of Arizona

Brent Munroe, M.D.

Department of Orthopaedic Surgery, University of Arizona

Deborah Baldemor, M.D.

Department of Family Medicine, University of Arizona

Kurt M. Mohty, Medical Student

College of Medicine, University of Arizona

For correspondence:
kmohty10@email.arizona.edu

Divneet Mandair

College of Medicine, University of Arizona

Brent Munroe, M.D.

Department of Orthopaedic Surgery, University of Arizona

Deborah Baldemor, M.D.

Department of Family Medicine, University of Arizona