WHEN TO SEE A SPINE SPECIALIST

You should seek the advice of a spine specialist if neck or back pain persists for more than two weeks or if it is progressive in intensity and/or distribution. You should seek immediate healthcare attention if neck or back pain occurs as the result of an injury or if it is associated with serious illness and/or a high fever. Additional signs and symptoms which warrant prompt medical attention include:

• Neck or back pain associated with bowel and/or bladder dysfunction
• Neck or back pain associated with extremity weakness or difficulty with coordination
• Extremity numbness or muscle weakness
• Neck or back pain that is associated with impaired walking (gait) or difficulty with balance
• Numbness, tingling and/or muscle weakness associated with a back or neck injury

SCREENING AND DIAGNOSIS

It is not necessary to screen for Schmorl’s nodes due to their asymptomatic and benign status.  They are usually first detected as an incidental finding on a spinal X-ray study. On X-ray Schmorl's nodes appear as a dark area (radiolucent) within the top or bottom portion of the vertebral body. A chronic Schmorl’s node is often surrounded by a whiter area of increased bone density referred to as sclerosis. This develops as the result of a bone reaction to the microtrauma. Schmorl’s nodes are a common incidental finding with advanced imaging of the spine such as CT and MRI. CT scans and MR imaging also show characteristic features. MRI studies show more detail about soft tissue changes surrounding the bony defect and the intrusion of disc material into the vertebral body than CT and X-ray.

In a patient with a large or progressive Schmorl’s nodes additional diagnostic assessment may include laboratory work to rule out systemic (blood) related causes of bone thinning which could render bone of the spine more susceptible to failing under a load.