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Br J Sports Med. 2008 Dec;42(12):969-73. doi: 10.1136/bjsm.2008.050369. Epub 2008 Aug 21.

Antibiotic treatment in patients with low-back pain associated with Modic changes Type 1 (bone oedema): a pilot study.

Author information

1
The Back Research Center, Lindevej 5, 5750 Ringe, Denmark. haal@shf.fyns-amt.dk

Abstract

OBJECTIVE:

The aim of this study was to assess the clinical effect of antibiotic treatment in a cohort of patients with low-back pain (LBP) and Modic changes Type 1 (bone oedema) following a lumbar herniated disc.

DESIGN:

This was a prospective uncontrolled trial of 32 LBP patients who had Modic changes and were treated with Amoxicillin-clavulanate (500 mg/125 mg) 3 x day for 90 days. All patients had previously participated in a randomised controlled trial (RCT) that investigated active conservative treatment for a lumbar herniated disc (n = 166). All patients in that RCT who had Modic changes and LBP at 14 months follow-up (n = 37) were invited to participate in this subsequent antibiotic trial but five did not meet the inclusion criteria.

RESULTS:

29 patients completed the treatment, as three patients dropped out due to severe diarrhoea. At the end of treatment and at long-term follow-up (mean 10.8 months) there was both clinically important and statistically significant (p<or=0.001) improvement in all outcome measures: LBP intensity, number of days with pain, disease-specific and patient-specific function, and global perceived effect.

CONCLUSIONS:

In this uncontrolled trial, the clinical effect of antibiotic treatment was large in a group of patients with Modic changes suffering from persistent LBP following a disc herniation. These results provide tentative support for a hypothesis that bacterial infection may play a role in LBP with Modic changes and indicate the need for randomised controlled trials to test this hypothesis.

PMID:
18718972
DOI:
10.1136/bjsm.2008.050369
[Indexed for MEDLINE]

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