A clinical and archaeological study of Schmorl’s nodes : using clinical data to understand the past
This study of Schmorl 's nodes in British populations past and present attempts to reach a better understanding of the origins and aetiology of Schmorl' s nodes and their impact upon the vertebral column in relation to age, sex, pre-existing skeletal lower limb asymmetry, and work patterns. Georg Schmorl has been accepted as the leading authority on the nodes he named. Eighty years later modem diagnostic radiographic imaging and macroscopic studies are used to reach informed answers to the questions of prevalence, relationship to other degenerative joint diseases of the spine, and the possibility of Schmorl's node recognition by clinicians when presented with specific pain location. The clinical samples studied were from Pinderfields Hospital, Wakefield, and the Royal Hospital for Sick Children, Edinburgh. The archaeological samples studied were from Captain's Cabin, Dunbar, The Hirsel, Coldstream and Whithom Priory, Galloway, all in Scotland, and St. Andrew, Fishergate, York, and Tanners Row, Pontefract in England, and dated to between the 6th and 16th centuries AD. The archaeological samples were from military and monastic settlements in urban and rural contexts. Congenital disorders and acute trauma affecting the spine, and alterations to the normal primary and secondary vertebral curves were studied in an attempt to prove or disprove a relationship to Schmorl's nodes. Macroscopic study of the vertebral columns from the archaeological samples, and radiographs of the clinical samples, were analysed, along with clinical case histories and known background information of the demography, settlement type and, the geographic and topographic locations for each sample. No weak area was found in the vertebral end plate. Positive proof for symptomatic Schmorl's nodes was found in the clinical samples. The greatest numbers of Schmorl' s nodes were not formed in the first two decades of life, but in the third and fourth decades. Scheuermann's disease may be indirectly attributable to subadult Schmorl's nodes. However, Schmorl's nodes may or may not precede scoliosis. Males and females Of similar ages from the same settlements did not produce. Similar frequencies, nor were similar patterns observed between samples. Further studies using larger and better-preserved samples, with good contextual evidence may help to provide clearer positive or, negative evidence for work related Schmorl's nodes.