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Nódulos de Schmorl - Hérnias de Disco

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O que são os Nódulos de Schmorl e qual é a relação deles com a dor de coluna?

Quais os cuidados terapêuticos que devem ser aplicados.

 

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    Nódulo de Schmorl - Hérnia de Schmorl:

 



 

 

 

 

Os Nódulos de Schmorl são protusões do material do disco vertebral para dentro da superficie do corpo da vértebra. Tais saliências são também associadas à necrose do osso vertebral. 

 

Os nódulos de Schmorl podem ou não ser sintomáticos, ou seja em alguns indivíduos pode ser causa de dor.

 

Entretanto estudos indicam que alguns individuos com os nódulos de Schmorl pode passar a vida inteira sem dor e os nódulos serem sescobertos apenas no estudo anatomopatológico i.e., estudos de necrópsia.

 

Ou seja, podem ter algum significado etiológico de dor nas costas , mas é uma questão controversa.

 

Schmorl é uma deformação significativa, e pode ser encontrada em pacientes com histórico de problemas ao longo da vida de volta.

 

Os nódulos de Schmorl podem ocorrer em várias vértebras e foram encontrados em pacientes com, dor crônica, radiculopatia, artrite, aracnoidite, estenose, desportiva ou outra lesão ou deficiência.


Mas como dito anteriormente, não necessariamente podem ser imputados como a causa da dor.

 

Os nódulos de Schmorl podem ser detectados pelo raio-x, embora possam ser melhor visualizados por tomografia computadorizada ou ressonância magnética.

 

Os Nódulos de Schmorl são considerados hérnias discais verticais que passam pelo placas terminais cartilaginosas do corpo vertebral.

 

Eles às vezes pode ser visto radiograficamente, porém eles são mais freqüentemente encontradas na ressonância magnética, mesmo quando não é visível na película de raio X lisas. Eles podem ou não ser sintomático, e seu significado etiológico de dor nas costas é controversa. Em um estudo recente na coluna, Hamanishi, et al., 1 de Schmorl nós foram observadas em MRI em 19% dos 400 pacientes com dor nas costas, e em apenas 9% de um grupo controle assintomático .. Os autores concluíram que Nódulos de Schmorl são áreas de "hérnia de disco vertical" por zonas de fraqueza na placa motora.

 
Nódulos de Schmorl são bastante comuns, especialmente com menor degeneração da coluna do envelhecimento, mas eles também são vistos nas espinhas mais jovens. Nódulos de Schmorl muitas vezes não causam sintomas, mas pode simplesmente refletir que "desgaste" da coluna vertebral ocorreu ao longo do tempo, podem também refletir o que a força do osso ao mesmo tempo foi um pouco comprometida, talvez devido a uma deficiência de vitamina D, embora isso tenha ainda a ser confirmada com estudos.

 
Os Nódulos de Schmorl também tendem a ocorrer mais frequentemente em casos de deformidades da coluna vertebral, especificamente na doença de Scheuermann.

 
O Epônimo Schmorl:

Nódulos de Schmorl foram batizados a partir do nome de patologista alemão Christian Georg Schmorl (1861-1932).

 

 

 

 

Referências:

 

Schmorl G, Junghans H. The human spine in health and disease New York, NY: Grune & Stratton, 1971; 158-172.

Paajanen H, Alanen A, Erkintalo M, Salminen JJ, Katevuo K. Disc degeneration in Scheuermann disease.Skeletal Radiol 1989; 18:523-526. CrossRefMedline

Stoddard A, Osborn JF. Scheuermann’s disease or spinal osteochondrosis: its frequency and relationship with spondylosis.J Bone Joint Surg Br 1979;61:56-58.

Cleveland RH, Delong GR. The relationship of juvenile lumbar disc disease and Scheuermann’s disease.Pediatr Radiol 1981; 10:161-164. CrossRefMedline

Resnick D, Niwayama G. Intravertebral disk herniations: cartilaginous (Schmorl’s) nodes.Radiology 1978; 126:57-65. Abstract/FREE Full Text

Hamanishi C, Kawabata T, Yosii T, Tanaka S. Schmorl’s nodes on magnetic resonance imaging: their incidence and clinical relevance.Spine1994; 19:450-453. Medline

Stabler A, Bellan M, Weiss M, Gartner C, Brossmann J, Reiser MF. MR imaging of enhancing intraosseous disk herniation (Schmorl’s nodes).AJR Am J Roentgenol 1997; 168:933-938. Abstract/FREE Full Text

Hansson T, Roos B. The amount of bone mineral and Schmorl’s nodes in lumbar vertebrae.Spine 1983; 8:266-271.CrossRefMedline

Macnab I. The traction spur: an indicator of segmental instability.J Bone Joint Surg Am1971; 53:663-670. Abstract/FREE Full Text

Resnick D, Niwayama G. Radiographic and pathologic features of spinal involvement in diffuse idiopathic skeletal hyperostosis (DISH).Radiology1976; 119:559-568. Abstract/FREE Full Text

Chan KK, Sartoris DJ, Haghighi P, et al. Cupid’s bow contour of the vertebral body: evaluation of pathogenesis with bone densitometry and imaging-histopathologic correlation.Radiology1997; 202:253-256.

Abstract/FREE Full TextHilton RC, Ball J, Benn RT. Vertebral end-plate lesions (Schmorl’s nodes) in the dorsolumbar spine.Ann Rheum Dis 1976; 35:127-132. Abstract/FREE Full Text

Frymoyer JW, Newberg A, Pope MH, Wilder DG, Clements J, MacPherson B. Spine radiographs in patients with low-back pain: an epidemiological study in men.J Bone Joint Surg Am 1984; 66:1048-1055. Abstract/FREE Full Text

Schmorl G. Über knorpelknötchen an den wirbelbandscheiben.Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 1928; 38:265-279.

Fahey V, Opeskin K, Silberstein M, Anderson R, Briggs C. The pathogenesis of Schmorl’s nodes in relation to acute trauma: an autopsy study.Spine 1998; 23:2272-2275. CrossRefMedline

Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries.Spine 1983; 8:817-831. Medline

Petersilge CA, Pathria MN, Emery SE, Masaryk TJ. Thoracolumbar burst fractures: evaluation with MR imaging.Radiology 1995; 194:49-54. Abstract/FREE Full Text

Seymour R, Williams LA, Rees JI, Lyons K, Lloyd DC. Magnetic resonance imaging of acute intraosseous disc herniation.Clin Radiol 1998;53:363-368. CrossRefMedline

Coventry MB, Ghormley RK, Kernohan JW. The intervertebral disc: its microscopic anatomy and pathology. III. Pathological changes in the intervertebral disc.J Bone Joint Surg 1945; 27:460-474. Abstract/FREE Full Text

Hassler O. The human intervertebral disc: a micro-angiographical study on its vascular supply at various ages.Acta Orthop Scand 1969; 40:765-772. Medline

Resnick D, Niwayama G. Subchondral resorption of bone in renal osteodystrophy.Radiology1976; 118:315-321. Abstract/FREE Full Text

Boukhris R, Becker KL. Schmorl’s nodes and osteoporosis.Clin Orthop1974; 0:275-280.

Hansson TH, Keller TS, Spengler DM. Mechanical behavior of the human lumbar spine. II. Fatigue strength during dynamic compressive loading.J Orthop Res 1987; 5:479-487. CrossRefMedline

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain.N Engl J Med 1994; 331:69-73. CrossRefMedline

 

 

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