THE PATHOGENESIS OF SCHMORLS-NODES IN RELATION TO ACUTE TRAUMA - AN AUTOPSY STUDY

Study Design. Seventy thoracolumbar spines from cadavers of individual s killed in motor vehicle accidents were examined pathologically and r adiologically, particularly for the occurrence of acute Schmorl's node s. Objectives. To document whether Schmorl's nodes occur acutely as a result of trauma. Summary of Background Data. Theories proposed to exp lain the pathogenesis of Schmorl's nodes include developmental, degene rative, traumatic, and disease influences. Few studies show a direct c ausal relation between a traumatic episode and acute Schmorl's node fo rmation. Methods. Thoracolumbar spines were removed at autopsy, underw ent radiography in the anteroposterior and lateral planes, fixed, sagi ttally cut, and underwent radiography a second time. Pathologic and ra diographic examinations were performed. Results. Nine acute Schmorl's nodes were detected, most in association with other acute injuries to the spine. Most acute Schmorl's nodes were present in spines from indi viduals aged 11-30 years, with a male to female ratio of 9:1, and were localized to the T8-L1 region. Spines from motorcyclists showed the h ighest percentage of acute Schmorl's nodes. No acute Schmorl's nodes w ere detected radiologically. Conclusion. Schmorl's nodes do occur acut ely as the result of a single traumatic episode, and are almost always associated with other acute spinal injury. The frequency and occurren ce of acute Schmorl's nodes in motorcyclists suggest that axial loadin g is an important mechanism. Their predominance in the T8-L1 region su ggests that this region is particularly susceptible to stress.