Original articles

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

H B Albert¹, C Manniche¹, J S Sorensen¹, B W Deleuran²

¹ The Back Research Center, Funen, University of Southern Denmark, Denmark
² Department of Rheumatology, Aarhus University Hospital and The Institute of Medical Microbiology and Immunology, Aarhus University, Aarhus, Denmark

Hanne Albert, The Back Research Center, Lindevej 5, 5750 Ringe, Denmark; haal{at}shf.fyns-amt.dk

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 (p0.001) 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.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Treating low back pain: Alexander technique and exercise, antibiotics (!) and Paul Hodges on dynamic stability

Karim M Khan
Br. J. Sports Med. 2008 42: 939-940. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Khan, K. M (2008). Treating low back pain: Alexander technique and exercise, antibiotics (!) and Paul Hodges on dynamic stability. Br. J. Sports. Med. 42: 939-940 [Full Text]