Symptomatic Schmorl's Nodes Inducing Severe Lower Back Pain in the Lumbar Spine: Two Case Reports

症狀性Schmorl's Nodes引發腰椎病變造成嚴重下背痛－兩病例報告

曾愛倫(Ailun Heather Tseng) ； 劉昌熾(Chang-Chih Liu)

《輔仁醫學期刊》 16卷4期 (2018/12) Pp. 175-182

https://doi.org/10.3966/181020932018121604003

摘要

Background and purpose: Schmorl's nodes (SNs) represent a thoracolumbar lesion, which are defined histologically as a loss of the nuclear material of intervertebral discs through the cartilage plate, growth plate, and endplate into the vertebral body. We report two cases of symptomatic SNs and assess the effect of two different surgical procedures to treat severe lower back pain caused by traumatic SNs. Case presentation: Two cases of symptomatic SNs with a history of trauma are presented. One involved a 15-year-old male patient and the other involved a 66-year-old female patient. The results of magnetic resonance imaging and X-ray confirmed the diagnosis of SNs. The male patient underwent laminotomy, discectomy, and insertion of a Rocker interspinous spacer under general anesthesia. The female patient underwent percutaneous vertebroplasty under local anesthesia. The visual analog scale was used to measure lower back pain before and after surgery. Both patients were asymptomatic at a 3-month follow-up; however, the male patient was readmitted due to new SN lesions 6 months after surgery. Conclusion: Both procedures were effective in relieving lower back pain from SNs, had a relatively short recovery time, and resulted in no postoperative complications. However, the male patient required further follow-up due to new lesions.

關鍵字

Schmorl's nodes ； percutaneous vertebroplasty ； discectomy ； laminectomy ； lower back pain ； magnetic resonance imaging

並列摘要

背景與目的：Schmorl's Nodes（SNs）是一種常見於胸腰椎的病變，其組織學上定義為失去的椎間盤髓核穿過軟骨板，生長板和終板進入鄰近的椎體。我們報告兩位有疼痛症狀的SNs病例，並評估兩種不同外科手術對於治療因創傷性SNs引起的嚴重下背痛的效果。個案報告：介紹了兩例具有創傷史的有疼痛症狀的SNs。一位是15歲的男性患者，另一位是66歲的女性患者。核磁共振成像和X光片的檢查結果證實了SNs的診斷。男性患者在全身麻醉下進行椎間盤切除術，椎板切開術並置入Roker棘突間支架等手術。而女性病患在局部麻醉下行經皮椎體成形術。視覺類比疼痛評分法（VAS）用於測量術前和術後的腰痛。追蹤手術治療3個月後，兩名患者皆無下背痛症狀，但男性患者於術後6個月因新增的SNs病灶再次入院。結論：兩種手術都能有效緩解SNs造成的下背痛，也能縮短恢復時間，並且無術後併發症。然而，因新病灶的產生，男性患者需要更進一步的追蹤病灶變化。

並列關鍵字

薛門氏節點 ； 經皮椎體成形術 ； 椎間盤切除手術 ； 椎板切開術 ； 下背痛 ； 核磁共振成像