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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_I | Pages 25 - 25
1 Jan 2012
THE ASSOCIATION BETWEEN VERTEBRAL ENDPLATE SIGNAL (MODIC) CHANGES AND LOW BACK PAIN IN THE GENERAL POPULATION
Jensen T Kjaer P Korsholm L Sorensen J Manniche C Leboeuf-Yde C
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Purpose

To investigate the association between vertebral endplate signal changes (VESC) and low back pain (LBP).

Methods and materials

This prospective observational study included 344 persons (161 men and 183 women) sampled from the Danish general population. All participants had an MRI and filled in questionnaires at the age of 40 and again at the age of 44. The following LBP outcomes were used: “LBP past month,” “LBP past year,” and “non-trivial LBP”. The type and size of VESC at each endplate level were evaluated using a standardized evaluation protocol. Associations between VESC and LBP were investigated using logistic regression analysis.

Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_I | Pages 26 - 26
1 Jan 2012
DO VERTEBRAL ENDPLATE SIGNAL (MODIC) CHANGES HURT?
Jensen T Kent P Karppinen J Sorensen J Niinimäki J Leboeuf-Yde C
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Purpose

By systematic literature review, to quantify the association between vertebral endplate signal changes (VESC) and non-specific low back pain (NSLBP).

Materials and methods

MEDLINE, EMBASE, and SveMED databases were searched for the period 1984 to June 2009. Articles were included which investigated the association between VESC and NSLBP and reported sufficient data to construct two-by-two tables. Articles on specific low back pain conditions were excluded. A standardised data collection and quality assessment were performed. To estimate the association between VESC and NSLBP, two-by-two tables were created and exact odds ratios were calculated with 95% confidence intervals (CI). Meta-analysis was performed on homogeneous studies.

Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_II | Pages 280 - 280
1 May 2009
ANTIBIOTIC TREATMENT OF PATIENTS WITH LOW BACK PAIN AND MODIC CHANGES: A PILOT STUDY
Albert H Manniche C Sorensen J Deleuran B
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Introduction: Modic changes have recently been identified as a pain giving pathoanatomical diagnosis for a considerable percentage (20–30 %) of Low Back Pain (LBP) patients. The causes of these Modic changes have not been determined conclusively.

The aim was to evaluate a possible effect of antibiotic treatment in an uncontrolled group of patients with LBP and Modic changes.

Methods: A cohort of patients (n=32) participated in this study. The patients had previous sciatic mostly from lumbar disc herniation, all were treated conservatively. At the 14 month follow-up, 43 of the patients had Modic changes, six of whom did not suffer from LBP, five declined participation. The treatment consisted of amoxicillin-clavulanate (500 mg/125 mg) (Spektramox ®) three times a day for 90 days.

Results: Twenty-nine patients completed the treatment, of which 15 (52 %) reported that they were much better or cured, 7 (24 %) experienced moderate improvement, and 7 (24 %) remained unchanged. None reported a worsening of symptoms. At the end of treatment and at long term follow-up (mean 10.8 months) there was both a clinically and statistically significant (p< 0.001) improvement found in all outcome parameters, namely; general health, disease and patient specific function, pain in the lumbar area, and number of days with pain.

Discussion: The clinical effect of antibiotic treatment was profound in a group of patients suffering from persistent low back pain after experiencing a disc herniation. Our results support the theory that bacterial infection could play a role in LBP with Modic changes.