Infliximab infusions for persistent back pain in two patients with Schmorl's nodes

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Abstract
Sir, Schmorl's nodes (SNs) are herniations of the nucleus pulposus (NP) material through the vertebral endplates into the trabecular bone. SNs are the most common non-intervertebral disc abnormalities in magnetic resonance imaging (MRI) in persons without back pain [1]. However, SNs are seldom symptomatic, and treatment with analgesics, non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroids usually improves back pain. In contrast to SNs, herniated intervertebral discs (HIDs) are a common cause of back and radicular pain. TNF-α from the NP does appear to be pathogenic to nerve roots in animal models of sciatica [2]. Furthermore, TNF-α blockade is effective in preventing NP-induced functional and structural nerve root injury in animal models [3]. The efficacy of the TNF-α inhibitors infliximab and etanercept in leg and back pain has recently been shown in patients with HID-induced sciatica [4, 5]. These results of TNF-α blockade prompted us to test infliximab infusions for refractory symptoms to conventional conservative treatment in two patients with painful SN.

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