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Zha G, He Y, Li G. A case of non-traumatic low back pain. Asian J Surg 2024:S1015-9584(24)01047-9. [PMID: 38824031 DOI: 10.1016/j.asjsur.2024.05.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 05/16/2024] [Indexed: 06/03/2024] Open
Affiliation(s)
- Gang Zha
- Zigong Hospital of TCM, 59 Machongkou Road, Zigong, 643010, China
| | - Yuyang He
- Southwest Medical University, 319 Zhongshan Road, Luzhou, 646099, China
| | - Guoqing Li
- Department of Orthopedics, Ningbo No. 6 Hospital, 1059 Zhongshan Dong Road, Ningbo, 315040, China.
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Park HJ, Jo HJ, Lee J, Choi SS, Lee CH. Percutaneous Vertebroplasty in a Patient with Chronic Back Pain Caused by Multiple Schmorl's Nodes: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1839. [PMID: 37893557 PMCID: PMC10608530 DOI: 10.3390/medicina59101839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Schmorl's nodes (SNs), formed by the herniation of intervertebral discs into adjacent vertebral bodies, are generally asymptomatic and do not require treatment. However, certain types of SNs can cause intractable back pain. Case Presentation: A 63-year-old man presented to our hospital with back pain after a fall 1 month prior. Physical examination revealed back pain that worsened with movement and paraspinal tenderness. Magnetic resonance imaging (MRI) performed immediately after presentation revealed subacute to chronic compression fractures with SNs at the upper endplates of the 11th and 12th thoracic and 1st lumbar vertebrae. Pain (numeric rating scale (NRS), 7-8/10) persisted despite 6 months of conservative treatment and MRI revealed increased signal intensity in T2-weighted images in the regions around the SNs. Based on these findings, an epidural nerve block was performed, and then repeated; however, no significant improvement was observed. Percutaneous vertebroplasty (PVP) was performed at the 11th and 12th thoracic and 1st lumbar vertebrae. Pain levels decreased substantially 1 week after PVP (NRS, 3-4/10). Subsequent treatment with non-steroidal anti-inflammatory drugs (NSAIDs) and steroids for two weeks further reduced pain levels (NRS, 1-2/10), following which steroid use was discontinued and NSAID use became intermittent. At the six-month follow-up, pain levels remained low and the patient reported an improvement in activity levels of 90% or more. Conclusions: This case report demonstrates that PVP safely and effectively improved symptoms in a patient with multiple SNs and intractable back pain. Nevertheless, further research, particularly large-scale randomized prospective studies, is necessary to validate the long-term efficacy and safety of this intervention.
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Affiliation(s)
- Hyung-Joon Park
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, 153 Gyeongchun Road, Guri 11923, Republic of Korea;
| | - Hyun-Ji Jo
- Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, 148 Gurodong Road, Seoul 08308, Republic of Korea; (H.-J.J.); (J.L.); (S.-S.C.)
| | - Jaeeun Lee
- Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, 148 Gurodong Road, Seoul 08308, Republic of Korea; (H.-J.J.); (J.L.); (S.-S.C.)
| | - Sang-Sik Choi
- Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, 148 Gurodong Road, Seoul 08308, Republic of Korea; (H.-J.J.); (J.L.); (S.-S.C.)
| | - Chung-Hun Lee
- Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, 148 Gurodong Road, Seoul 08308, Republic of Korea; (H.-J.J.); (J.L.); (S.-S.C.)
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Cai K, Jiang G, Lu B, Zhang K, Luo K. Bone cement distribution may significantly affect the efficacy of percutaneous vertebroplasty in treating symptomatic Schmorl's nodes. BMC Musculoskelet Disord 2023; 24:473. [PMID: 37296434 DOI: 10.1186/s12891-023-06575-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
PURPOSE Percutaneous vertebroplasty(PVP) has been widely used in treating symptomatic Schmorl's nodes(SNs). However, there were still some patients with poor pain relief. At present, there is a lack of research to analyze the reasons for poor efficacy. METHODS Review the SNs patients treated with PVP in our hospital from November 2019 to June 2022, collect their baseline data. Reverse reconstruction software was used to calculate the filling rate of bone edema ring(Rf). NRS score was used to evaluate pain and ODI to evaluate function. The patients were divided into remission group(RG) and non remission group(n-RG) according to symptom. In addition, according to the Rf, they were divided into excellent, good and poor groups. Differences between groups were investigated. RESULTS A total of 26 vertebrae were included in 24 patients. When grouped according to symptoms, patients in n-RG were older, and surgical segments were tend to locate in lower lumbar spine. The proportion of Poor distribution was significantly higher. When grouped according to the cement distribution, the preoperative NRS and ODI of the three groups were comparable, but the NRS and ODI of Poor group were significantly worse than the Excellent and Good groups postoperatively and at the last follow-up. CONCLUSIONS The cement distribution may significantly affect the efficacy of PVP in treating symptomatic SNs. We suggest that the bone edema ring should be filled as fully as possible to ensure the efficacy. In addition, advanced age and low lumbar lesions are also adverse factors for clinical outcomes.
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Affiliation(s)
- Kaiwen Cai
- Department of Orthopaedic, The First Hospital Of Ningbo University, No. 247, Renmin Road, Jiangbei District, Ningbo, Zhejiang, People's Republic of China
- Institute of Orthopaedics, Ningbo University, No. 247, Renmin Road, Jiangbei District, Ningbo, Zhejiang, People's Republic of China
| | - Guoqiang Jiang
- Department of Orthopaedic, The First Hospital Of Ningbo University, No. 247, Renmin Road, Jiangbei District, Ningbo, Zhejiang, People's Republic of China
- Institute of Orthopaedics, Ningbo University, No. 247, Renmin Road, Jiangbei District, Ningbo, Zhejiang, People's Republic of China
| | - Bin Lu
- Department of Orthopaedic, The First Hospital Of Ningbo University, No. 247, Renmin Road, Jiangbei District, Ningbo, Zhejiang, People's Republic of China
- Institute of Orthopaedics, Ningbo University, No. 247, Renmin Road, Jiangbei District, Ningbo, Zhejiang, People's Republic of China
| | - Kai Zhang
- Department of Orthopaedic, The First Hospital Of Ningbo University, No. 247, Renmin Road, Jiangbei District, Ningbo, Zhejiang, People's Republic of China
- Institute of Orthopaedics, Ningbo University, No. 247, Renmin Road, Jiangbei District, Ningbo, Zhejiang, People's Republic of China
| | - Kefeng Luo
- Department of Orthopaedic, The First Hospital Of Ningbo University, No. 247, Renmin Road, Jiangbei District, Ningbo, Zhejiang, People's Republic of China.
- Institute of Orthopaedics, Ningbo University, No. 247, Renmin Road, Jiangbei District, Ningbo, Zhejiang, People's Republic of China.
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