J Korean Soc Spine Surg.  2018 Dec;25(4):147-153. 10.4184/jkss.2018.25.4.147.

The Therapeutic Effect of Postganglionic Nerve Block for Symptomatic Schmorl Nodule: A Retrospective Case Series

• Son IS
• Hwang SH
• Lee SH
• Kang MS

• KMID: 2430139
• DOI: http://doi.org/10.4184/jkss.2018.25.4.147

Abstract

STUDY DESIGN: Retrospective case series.
OBJECTIVES
We retrospectively evaluated the clinical efficacy of postganglionic nerve block in symptomatic Schmorl nodules (SNs). SUMMARY OF LITERATURE REVIEW: SNs are common lesions that are often asymptomatic. In certain cases, SNs have been reported to cause severe axial back pain, thereby considerably impacting patients' quality of life. No consensus currently exists on the treatment of symptomatic SNs.
MATERIALS AND METHODS
From October 2015 to October 2017, a total of 21 patients with symptomatic SNs diagnosed by magnetic resonance imaging (MRI) that did not respond to conservative treatment after 4 weeks were included in the study. All patients received postganglionic nerve block. We evaluated effective pain relief (improvement of back pain of more than 50% compared with before the intervention) and functional improvements, assessed by visual analogue scale (VAS) and Oswestry Disability Index scores obtained at 4 hours, 4 weeks, 8 weeks, 3 months, and 6 months after the procedure.
RESULTS
Symptomatic SNs were more common at the L2-3 level, and the lower end plate was more commonly involved than the upper end plate. Eighteen of the 21 patients (85.7%) showed effective pain relief, and no deterioration was observed within the follow-up period. Throughout the follow-up period, the VAS remained significantly improved compared to before the procedure (p < 0.05). Complications were not reported in any cases.
CONCLUSIONS
Postganglionic nerve block for symptomatic SNs that do not respond to conservative treatment is a non-invasive modality for pain relief.

Keyword

Schmorl's nodule; Nerve block; Postganglionic; Sinuvertebral nerve; Rami-communicans

MeSH Terms

Back Pain
Consensus
Follow-Up Studies
Humans
Magnetic Resonance Imaging
Nerve Block*
Quality of Life
Retrospective Studies*
Treatment Outcome