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Antibiotic treatment in patients with low back pain associated with Modic changes Type 1 (bone oedema): a pilot study
  1. Hanne B. Albert (haal{at}shf.fyns-amt.dk)
  1. The Back Research Center, Funen, University of Southern Denmark, Denmark
    1. Claus Manniche
    1. The Back Research Center, Funen, University of Southern Denmark, Denmark
      1. Joan S. Sorensen
      1. The Back Research Center, Funen, University of Southern Denmark, Denmark
        1. Bent W. Deleuran
        1. Dept. of Rheumatology, Aarhus University Hospital, and The Institute of Medical Microbiology and Imm, Denmark

          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 randomized 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: Twenty-nine 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 a clinically important and statistically significant (p< 0.001) improvement in all outcome measures: LBP intensity, number of days with pain, disease- 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.

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