Central Schmorl’s Nodes at All Levels (Developmental Endplate Depressions)
Updated: Oct 25
Case: 46-year-old female patient.
Figure 1a & 1b Sagittal T1- and T2-weighted MR images demonstrate multilevel central endplate depressions with similar morphology across the imaged vertebral levels. The red arrow indicates a representative depression. Disc spaces are generally preserved, although some discs show reduced T2 signal. No conspicuous surrounding bone marrow edema is evident on the provided images
Radiological Findings:
Symmetrically located Schmorl’s nodes are observed in the central portions of both the superior and inferior endplates across the imaged vertebral bodies.
Intervertebral disc heights are generally preserved.
No conspicuous Modic changes or surrounding bone marrow edema are evident on the provided images
No significant sagittal malalignment is evident
Differential Diagnostic Considerations
No conspicuous surrounding marrow edema is evident to suggest an acute edematous Schmorl’s node. No marked anterior vertebral wedging is seen in the imaged region to support classic Scheuermann’s disease. Vertebral body heights are generally preserved, without a conspicuous compression deformity. Preserved disc spaces do not exclude accompanying disc degeneration.
Diagnosis and Clinical Interpretation
The multilevel endplate depressions, with a relatively consistent central distribution and morphology, favor a predominantly developmental pattern of Schmorl’s nodes (SNd). Vertebral body heights and intervertebral disc spaces are generally preserved. No conspicuous surrounding bone marrow edema is evident on the provided T1- and T2-weighted images.
Developmental endplate weakness related to notochord regression is one proposed predisposing mechanism. However, this imaging appearance does not demonstrate persistent notochordal tissue or establish a specific embryological cause.
The findings favor a chronic appearance. Their relationship to symptoms cannot be determined from imaging alone.
Key Takeaways for Radiologists and Residents
Primary Finding: Multiple centrally located endplate depressions with similar morphology across the imaged vertebral levels.
Interpretation: The distribution favors predominantly developmental Schmorl’s nodes.
Etiological Consideration: Notochord regression-related endplate weakness is a proposed mechanism, rather than a confirmed cause in this patient.
Diagnostic Key: Evaluate the distribution, vertebral morphology, surrounding marrow signal, and associated disc changes together. Absence of edema alone does not establish developmental origin or exclude degeneration.
Clinical Significance: Clinical correlation is required before attributing symptoms to these findings or making management recommendations.
References
1. Wáng YXJ. Schmorl’s node of primarily developmental cause and Schmorl’s node of primarily acquired cause: two related yet different entities. Quant Imaging Med Surg. 2023;13(6):4044–4049. doi: 10.21037/qims-23-252.Full text
2. Wáng YXJ. Cartilaginous endplate coverage of developmental Schmorl’s node and the relevance of this in Schmorl’s node etiology-based classification. Quant Imaging Med Surg. 2024;14(6):4288–4303. doi: 10.21037/qims-24-335.Full text
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