Treatment of Painful One Level Schmorl’s Nodes Using Percutaneous Endoscopic Lumbar Discectomy: A Clinical Evaluation

Zihao Ding,1,* Jie Wang,1,* Li Guan,1 Yuzeng Liu,1 Yaoshen Zhang,1 Yong Hai1– 4 1Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Joint Laboratory for Research & Treatment of Spinal Cord Injury in Spinal Deformity, Capital Medical University, Beijing, People’s Republic of China; 3Laboratory for Clinical Medicine, Capital Medical University, Beijing, People’s Republic of China; 4Clinical Center for Spinal Deformity, Capital Medical University, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yong Hai, Email [email protected] Yaoshen Zhang, Email [email protected]: Herniations of the intervertebral disc into the vertebral body, known as Schmorl’s nodes (SNs), are frequently associated with degenerative disc disease (DDD). Painful SNs can contribute to discogenic lower back pain associated with DDD. Studies show that percutaneous endoscopic lumbar discectomy (PELD) yields favorable treatment outcomes for degenerative spinal diseases. This study retrospectively evaluated the efficacy of PELD in treating painful SNs.Objective: To evaluate the clinical efficacy and safety of PELD in treating patients with painful SNs.Methods: From February 1, 2020, to February 1, 2023, 13 patients with discogenic back pain from painful SNs (confirmed via intraoperative discography) who underwent single-level PELD at the index SN level were enrolled in the current study. Clinical data were retrospectively analyzed. Outcome measures, including the visual analog scale (VAS) for back pain and the Oswestry Disability Index (ODI), were recorded preoperatively and at 1 day, 6 months, and 12 months postoperatively. MRI scans of the lumbar region for all patients were evaluated preoperatively and again at the one-month follow-up.Results: All 13 patients were successfully treated with percutaneous endoscopic lumbar discectomy (PELD), showing significant postoperative improvements in VAS and ODI scores. Postoperative lumbar MRI revealed degenerative disc material in the SN cavities, which was removed using PELD. No surgical issues such as infections or nerve root damage, were noted.Conclusion: Postoperative MRI confirmed the removal of degenerative disc material, reinforcing PELD’s efficacy in treating the pathological changes associated with painful SNs. No surgical complications, such as infections or nerve root damage, were seen, underscoring the safety of PELD. This study demonstrates that PELD effectively manages discogenic lower back pain caused by SNs.Plain Language Summary: New knowledge added by this studyThis study presents preliminary evidence supporting a minimally invasive surgery called PELD for painful Schmorl’s nodes.By using postoperative MRI, this study is the first to confirm that the damaged disc material can be removed through this method.The study also provides early evidence of symptom relief lasting up to 27 months.Implications for clinical practice or policyPELD may be a safe and effective option for patients with Schmorl’s node-related back pain who do not improve with other treatments.MRI and discography can help identify patients who may benefit from this approach.These findings may support wider use of PELD and reduce the need for open surgery in select cases.Keywords: percutaneous endoscopic lumbar discectomy, PELD, Schmorl’s Nodes, SNs, discogenic lower back pain