Question
I have hip pain that came on suddenly about 2 years ago and wonder if it is necessary to have surgery.  I have a large Schmorl's node in the right half of the inferior endplate of L4 causing endplate marrow edema and mild diffuse disc bulge at L1, L2, L3, L4 and L5.  I am on celebrex and am able to work as long as I take it.  I have some numbness down the right leg and foot area but so far it's not major.  Thanks for answering.

Answer
Dear Joy,

At this point I would say that surgery is not necessary, however I do not have all the information.  Specifically, I do not know what you have done in the past 2 years in the form of treatment to eliminate pain while increasing your function.  What have you tried...physical therapy, chiropractic care, decompression, acupuncture?  Has anything helped? Have you tried anything yet?  Is your condition getting worse, staying the same or improving?

You see the MRI is just a piece of the puzzle and only tells us about the condition of the anatomical structures.  It gives no information about your daily function, or how pain interferes with activities of daily living.  Furthermore, conservative measure to help function and reduce pain should always be tried before surgery in cases like this.  Now, if you have been doing all of those things and not getting better, then yes surgery is an option to consider at this point.  

Lastly, considering the schmorl's node, I would have to guess it is an active condition rather than old formation.  I say this because you only mentioned the presence of one node, and considering the fact that you have stated there is an increased bone marrow signal indicating edema. This is not a good sign because it can be an indication that the endplate of the vertebra may be fractured.  The best way to document this is not on MRI however, a SPECT scan is more appropriate to visualize the integrity of the endplate. I would suggest that you discuss this with your doctors first before getting the SPECT, because schmorl nodes are a common radiographic finding and most require no treatment because they are developmental in nature due to disk pressure, not due to acute fracture.


Hope this helps Joy.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net