Central Schmorl’s Nodes at All Levels (Developmental Endplate Depressions)

Case: 46-year-old female patient.

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Figure 1a & 1b. Sagittal T1- and T2-weighted MR images demonstrating identical, symmetrical, and central endplate depressions (developmental Schmorl’s nodes) across all thoracolumbar levels (red arrow). Note the completely preserved intervertebral disc heights, normal signal intensity, and the total absence of surrounding bone marrow edema or Modic changes on both sequences.

Radiological Findings:

• Symmetrically located Schmorl’s nodes are observed in the central portions of both the superior and inferior endplates across all thoracolumbar vertebral bodies.

• Intervertebral disc heights are completely preserved.

• There is no accompanying Modic degeneration or bone marrow edema.

• No significant scoliosis or alignment abnormality is observed.

  
  

Differential Diagnosis Exclusion (Why Other Diagnoses Were Ruled Out):

• Ruled Out Acute/Symptomatic Schmorl’s Node: Because no Modic Type 1 (STIR/T2 hyperintense) edema or acute inflammatory response was observed in the adjacent bone marrow.

• Ruled Out Classic Scheuermann’s Disease: Because loss of anterior vertebral body height (anterior wedging) and significant thoracic hyperkyphosis were absent.

• Ruled Out Osteoporotic/Metabolic Collapse (Fish Vertebra / Biconcave Vertebra): Because vertebral body heights were fully preserved and the endplate changes were restricted solely to central, symmetric depressions.

• Ruled Out Secondary Degenerative / Mechanical Damage: Because intervertebral disc heights were completely preserved and no advanced degenerative disc pathology was present.

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Conclusion and Final Diagnosis:

• Diagnosis / Clinical Approach: Lacking accompanying bone marrow edema or secondary degenerative processes, and displaying a distinct symmetrical pattern centrally at all levels, this presentation represents a chronic-developmental/physiological endplate variation originating from persistent notochordal remnants (chorda dorsalis) (developmental central Schmorl’s nodes).

• Focal weaknesses (locus minoris resistentiae) along the regression tracts of the chorda dorsalis during the embryological period may predispose to such symmetric and central indentations across all levels in adulthood.

• It is considered a non-pathological developmental variant and does not represent a clinically active pathological process.

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📌 Key Takeaways for Radiologists & Residents

• Primary Finding: Symmetrical, central endplate depressions across all thoracolumbar levels.

• Etiology: Persistent notochordal remnants (chorda dorsalis regression line weakness).

• Diagnostic Key: Absence of bone marrow edema (STIR/T2) and preserved disc heights rule out acute/degenerative pathology.

• Clinical Significance: Benign developmental variant; requires no intervention or follow-up.