Journal of Korean Medicine Rehabilitation (한방재활의학과학회지)

The society of Korean Medicine Rehabilitation (한방재활의학과학회)
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Two Case of Symptomatic Schmorl's Node: A Case Report and Literature Review

Symptomatic Schmorl's Node로 인한 요통과 비신경근성 하지통을 호소하는 환자에 대한 보존적 치료 치험 2예: 증례보고 및 문헌고찰

  • Kang, Shinwoo (Department of Korean Medicine Rehabilitation, Dongguk University Bundang Oriental Hospital) ;
  • Choi, Seonghwan (Department of Korean Medicine Rehabilitation, Dongguk University Bundang Oriental Hospital) ;
  • Park, Hyeonsun (Department of Korean Medicine Rehabilitation, Dongguk University Bundang Oriental Hospital) ;
  • Park, Seohyun (Department of Korean Medicine Rehabilitation, Dongguk University Bundang Oriental Hospital) ;
  • Keum, Dongho (Department of Korean Medicine Rehabilitation, Dongguk University Bundang Oriental Hospital)
  • 강신우 (동국대학교 분당한방병원 한방재활의학과) ;
  • 최성환 (동국대학교 분당한방병원 한방재활의학과) ;
  • 박현선 (동국대학교 분당한방병원 한방재활의학과) ;
  • 박서현 (동국대학교 분당한방병원 한방재활의학과) ;
  • 금동호 (동국대학교 분당한방병원 한방재활의학과)
  • Received : 2021.09.14
  • Accepted : 2021.10.07
  • Published : 2022.01.31
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Abstract

The objective was to propose effectiveness of conservative treatments including Korean medical treatments for symptomatic Schmorl's nodes (SNs). We conducted retrospective study that analyzed the medical records of two patients with the symptomatic SNs. They were treated by conservative treatments including Korean medical treatments for 3 weeks. We evaluated numeric rating scale (NRS), Oswestry disability index (ODI) and EuroQol-5 dimension (EQ-5D) index. After treatment, NRS, ODI were decreased and EQ-5D index was increased. We performed literature search to analyze the mechanisms of its treatment and evaluate clinical trials. There were three major mechanisms: (1) Improving constructive stability of vertebrae, (2) alleviating pain, and (3) controlling autoimmunity. When comparing operative treatment (OT) trials and conservative treatment (CT) trials, we couldn't find conclusive basis that support which one is more effective. As OT trials reported some severe adverse events, CT trials reported mild adverse events. The conservative treatments that we used encompasses those mechanisms and is relatively safe. To obtain exact evidence of effectiveness, further studies are needed.

Keywords

References

  1. Schmorl G, Junghanns H. The human spine in health and disease. 2nd ed. New York:Grune and Stratton. 1971.
  2. Takahashi K, Miyazaki T, Ohnari H, Takino T, Tomita K. Schmorl's nodes and low-back pain. European Spine Journal. 1995;4(1):56-9. https://doi.org/10.1007/BF00298420
  3. Williams F, Manek N, Sambrook P, Spector T, Macgregor A. Schmorl's nodes: common, highly heritable, and related to lumbar disc disease. Arthritis Care & Research: Official Journal of the American College of Rheumatology. 2007;57(5):855-60.
  4. Kyere KA, Than KD, Wang AC, Rahman SU, Valdivia-Valdivia JM, La Marca F, Park P. Schmorl's nodes. European Spine Journal. 2012;21(11):2115-21. https://doi.org/10.1007/s00586-012-2325-9
  5. Grive E, Rovira A, Capellades J, Rivas A, Pedraza S. Radiologic findings in two cases of acute Schmorl's nodes. American Journal of Neuroradiology. 1999;20(9):1717-21.
  6. Zhang Y, Yin P, Yang J, Hai Y. Percutaneous vertebroplasty (PVP) to treat specialized type of endplate fractures around the Schmorl's node: a prospective study of 65 patients. Journal of Orthopaedic Surgery and Research. 2020;15(1):1-9. https://doi.org/10.1186/s13018-019-1510-5
  7. Neves N, da Silva MR, Rodrigues PC, Silva M, Matos R, Pinto R. Symptomatic giant Schmorl's node treated by a decompression procedure. Orthopaedics & Traumatology: Surgery & Research. 2013;99(3):371-4. https://doi.org/10.1016/j.otsr.2013.01.004
  8. Jang JS, Kwon HK, Lee JJ, Hwang SM, Lim SY. Rami communicans nerve block for the treatment of symptomatic Schmorl's nodes-a case report. The Korean Journal of Pain. 2010;23(4):262. https://doi.org/10.3344/kjp.2010.23.4.262
  9. Sakellariou G, Chatzigiannis I, Tsitouridis I. Infliximab infusions for persistent back pain in two patients with Schmorl's nodes. Rheumatology (Oxford, England). 2005;44(12):1588-90.
  10. Nam DJ, Oh MS. Characteristics of 601 low back pain patients: a Korean medicine hospital experience, retrospective chart review. J Korean Med Rehabil. 2015;25(2):135-53. https://doi.org/10.18325/JKMR.2015.25.2.135
  11. Thong ISK, Jensen MP, Miro J, Tan G. The validity of pain intensity measures: what do the NRS, VAS, VRS, and FPS-R measure? Scand J Pain. 2018;18(1):99-107. https://doi.org/10.1515/sjpain-2018-0012
  12. Fairbank JC, Pynsent PB. The Oswestry disability index. Spine (Phila Pa 1976). 2000;25(22):2940-52. https://doi.org/10.1097/00007632-200011150-00017
  13. Lee YK, Nam HS, Chuang LH, Kim KY, Yang HK, Kwon IS, Kind P, Kweon SS, Kim YT. South Korean time trade-off values for EQ-5D health states: modeling with observed values for 101 health states. Value Health. 2009;12(8):1187-93. https://doi.org/10.1111/j.1524-4733.2009.00579.x
  14. Abu-Ghanem S, Ohana N, Abu-Ghanem Y, Kittani M, Shelef I. Acute schmorl node in dorsal spine: an unusual cause of a sudden onset of severe back pain in a young female. Asian Spine Journal. 2013;7(2):131. https://doi.org/10.4184/asj.2013.7.2.131
  15. Fahey V, Opeskin K, Silberstein M, Anderson R, Briggs C. The pathogenesis of Schmorl's nodes in relation to acute trauma: an autopsy study. Spine. 1998;23(21):2272-5. https://doi.org/10.1097/00007632-199811010-00004
  16. Dar G, Masharawi Y, Peleg S, Steinberg N, May H, Medlej B, Peled N, Hershkovitz I. Schmorl's nodes distribution in the human spine and its possible etiology. European Spine Journal. 2010;19(4):670-5. https://doi.org/10.1007/s00586-009-1238-8
  17. Hilton R, Ball J, Benn R. Vertebral end-plate lesions (Schmorl's nodes) in the dorsolumbar spine. Annals of the Rheumatic Diseases. 1976;35(2):127-32. https://doi.org/10.1136/ard.35.2.127
  18. Sward L, Hellstrom M, Jacobsson B, Nyman R, Peterson L. Disc degeneration and associated abnormalities of the spine in elite gymnasts. A magnetic resonance imaging study. Spine. 1991;16(4):437-43. https://doi.org/10.1097/00007632-199104000-00009
  19. Zhang N, Li F-C, Huang Y-J, Teng C, Chen W-S. Possible key role of immune system in Schmorl's nodes. Medical Hypotheses. 2010;74(3):552-4. https://doi.org/10.1016/j.mehy.2009.09.044
  20. Son IS, Hwang SH, Lee SH, Kang MS. The therapeutic effect of postganglionic nerve block for symptomatic schmorl nodule: a retrospective case series. Journal of Korean Society of Spine Surgery. 2018;25(4):147-53. https://doi.org/10.4184/jkss.2018.25.4.147
  21. Kim S, Jang S. Radicular pain caused by Schmorl's node: a case report. Revista Brasileira de Anestesiologia. 2018;68(3):322-4.
  22. Hershkovich O, Koch JE, Grevitt MP. Schmorl node-a cause of acute thoracic pain: a case report and pathophysiological mechanism. International Journal of Spine Surgery. 2020;14(3):441-6. https://doi.org/10.14444/7058
  23. Swain AJ, Evans CC. The effectiveness of a home exercise program for a young athlete with Schmorl's nodes: a case report. Global Journal of Medical and Clinical Case Reports. 2014;1(1):13-20.
  24. Masala S, Pipitone V, Tomassini M, Massari F, Romagnoli A, Simonetti G. Percutaneous vertebroplasty in painful schmorl nodes. Cardiovascular and Interventional Radiology. 2006;29(1):97-101. https://doi.org/10.1007/s00270-005-0153-6
  25. Wenger M, Markwalder T-M. Fluoronavigation-assisted, lumbar vertebroplasty for a painful Schmorl node. Journal of Clinical Neuroscience. 2009;16(9):1250-1. https://doi.org/10.1016/j.jocn.2008.11.016
  26. He SC, Zhong BY, Zhu HD, Fang W, Chen L, Guo JH, Deng G, Teng GJ. Percutaneous vertebroplasty for symptomatic Schmorl's nodes: 11 cases with long-term follow-up and a literature review. Pain Physician. 2017;20(2):69-76.
  27. Zhi-Yong S, Huan Z, Feng L, Nan-Ning L, Xiao-Yu Z, Bin P, Jun L, Zhong-Lai Q, Zhi-Ming Z, Hui-Lin Y. A retrospective study of percutaneous balloon kyphoplasty for the treatment of symptomatic Schmorl's nodes: 5-year results. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. 2017;23:2879. https://doi.org/10.12659/MSM.904802
  28. Nie FF, Chen B, Zhang YH, Huang SG, Ju L. Retrospective study of percutaneous vertebroplasty treatment for Schmorl nodes. Chinese Journal of Pain Medicine. 2018;2:117-21.
  29. Amoretti N, Guinebert S, Kastler A, Torre F, Andreani O, Foti P, Cornelis F, Theumann N, Hauger O. Symptomatic Schmorl's nodes: role of percutaneous vertebroplasty. Open study on 52 patients. Neuroradiology. 2019;61(4):405-10. https://doi.org/10.1007/s00234-019-02171-7
  30. Iampreechakul P, Lertbutsayanukul P, Suanprasert N. Acute calcific discitis or symptomatic calcified schmorl's node of the upper thoracic spine in an adult: a case report and literature review. Asian Journal of Neurosurgery. 2019;14(3):1021. https://doi.org/10.4103/ajns.ajns_119_19
  31. Trotti A, Colevas AD, Setser A, Rusch V, Jaques D, Budach V, Langer C, Murphy B, Cumberlin R, Coleman CN, Rubin P. CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol. 2003;13(3):176-81. https://doi.org/10.1016/S1053-4296(03)00031-6
  32. Callaghan JP, McGill SM. Low back joint loading and kinematics during standing and unsupported sitting. Ergonomics. 2001;44(3):280-94. https://doi.org/10.1080/00140130118276
  33. Budidha K, Kyriacou PA. Photoplethysmography for quantitative assessment of sympathetic nerve activity (SNA) during cold stress. Frontiers in Physiology. 2019;9(1863):1-10.
  34. Schlereth T, Birklein F. The sympathetic nervous system and pain. Neuromolecular Med. 2008;10(3):141-7. https://doi.org/10.1007/s12017-007-8018-6
  35. Lee YG. The physical examination of low back pain. Clinical Pain. 2003;2(2):92-7.
  36. Yilmaz S, Kaya E, Yilmaz E, Kavakli A, Gurbuz S, Ozkaraca M. Effect of acupuncture therapy on fracture healing in rats with femur fractures. Journal of Traditional Chinese Medicine. 2020;40(2):275-83.
  37. Wang D, Bao F, Wu Z, Sun H, Zhang Y. Influence of acupuncture on IL-1beta and TNF-alpha expression in the cartilage of rats with knee osteoarthritis. China Journal of Orthopaedics and Traumatology. 2011;24(9):775-8. https://doi.org/10.3969/j.issn.1003-0034.2011.09.019
  38. Paolucci T, Pezzi L, Centra AM, Giannandrea N, Bellomo RG, Saggini R. Electromagnetic field therapy: a rehabilitative perspective in the management of musculoskeletal pain-a systematic review. Journal of Pain Research. 2020;13:1385. https://doi.org/10.2147/JPR.S231778
  39. Jiang X, Savchenko O, Li Y, Qi S, Yang T, Zhang W, Chen J. A review of low-intensity pulsed ultrasound for therapeutic applications. IEEE Transactions on Biomedical Engineering. 2018;66(10):2704-18. https://doi.org/10.1109/tbme.2018.2889669
  40. Kim JY, Koh HG, Nam SS. The recent study on pain modulation of acupuncture. J Korean Acupunct Moxib Soc. 2006;23(1):145-54.
  41. Jeon S-W, Nam H-J, Kim J-M, Lee W-G, Kim Y-B. Review on mechanism and efficacy of acupuncture stimulation-relationship between acupuncture stimulation and autonomic nervous system. Journal of Physiology & Pathology in Korean Medicine. 2010;24(5):748-52.
  42. Yoon JW, Kim SJ. A review of clinical study on Jungsongouhyul pharmacopuncture treatment published in Korea. Journal of Korean Medicine. 2017;27(4):75-84.
  43. Eun JS, Kim JH, Chae YJ, Cho HW, Kim JS, Kim C. The effectiveness of pulsed electromagnetic fields therapy for treatment of chronic pain. The Korean Journal of Pain. 2004;17(2):7.
  44. Grote V, Lackner H, Kelz C, Trapp M, Aichinger F, Puff H, Moser M. Short-term effects of pulsed electromagnetic fields after physical exercise are dependent on autonomic tone before exposure. European Journal of Applied Physiology. 2007;101(4):495-502. https://doi.org/10.1007/s00421-007-0520-x
  45. Han BH, Yoon JJ, Kim HY, Ahn YM, Hong MH, Son CO, Na SW, Lee YJ, Gang DG, Lee HS. Inhibitory effects of Ojeoksan on TNF-α-induced vascular inflammation in human umbilical vein endothelial cells. The Korea Journal of Herbology. 2018;33(4):59-67. https://doi.org/10.6116/KJH.2018.33.4.59
  46. Lee NH, Ha HK, Lee HY, Jung DY, Choi JY, Lee JK, Shin HK. Analysis of studies on Ojeok-san for establishment of evidence based medicine. Herbal Formula Science. 2008;16(2):1-9.