10 Years of Research: From Ignoring Modic Changes to Considerations Regarding Treatment and Prevention of Low-Grade Disc Infections

Manniche, Claus; Jordan, Alan

doi:10.4155/fsoa-2016-0017

Cited by 14 publications

(10 citation statements)

References 28 publications

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“…Factors associated with endplate damage following degenerative disc disease, ingrowth of new vessels, and collection of inflammatory agents may be important characteristics in the generation of pain [ 5 , 6 , 11 , 16 ]. In the normal state, bony endplates have a rich supply of small free nerve endings; degeneration and inflammation will likely trigger the inflammatory pain [ 13 ] (Figures 3 and 4 ).…”

Section: Discussionmentioning

confidence: 99%

“…The Modic change is closely associated with low back pain [ 9 ]. A recent study showed that, in nonspecific low back pain (LBP), the prevalence of any type of Modic change was 46%, as opposed to 6% in the general population [ 10 – 13 ]. Most individuals with Modic changes of more than 90% on MRI will have back pain within one year [ 8 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Transforaminal Epiduroscopic Basivertebral Nerve Laser Ablation for Chronic Low Back Pain Associated with Modic Changes: A Preliminary Open-Label Study

Kim

Adsul

Yudoyono

et al. 2018

Pain Research and Management

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Background Chronic low back pain (CLBP) arising from degenerative disc disease continues to be a challenging clinical and diagnostic problem whether treated with nonsurgical, pain intervention, or motion-preserving stabilization and arthrodesis. Methods Fourteen patients with CLBP, greater than 6 months, unresponsive to at least 4 months of conservative care were enrolled. All patients were treated successfully following screening using MRI findings of Modic type I or II changes and positive confirmatory provocative discography to determine the affected levels. All patients underwent ablation of the basivertebral nerve (BVN) using 1414 nm Nd:YAG laser-assisted energy guided in a transforaminal epiduroscopic approach. Macnab's criteria and visual analog scale (VAS) score were collected retrospectively at each follow-up interval. Results The mean age was 46 ± 9.95 years. The mean symptoms duration was 21.21 ± 21.87 months. The mean follow-up was 15.3 ± 2.67 months. The preoperative VAS score of 7.79 ± 0.97 changed to 1.92 ± 1.38, postoperatively (P < 0.01). As per Macnab's criteria, seven patients (50%) had excellent, six patients (42.85%) had good, and one patient (7.14%) had fair outcomes. Conclusion The transforaminal epiduroscopic basivertebral nerve laser ablation (TEBLA) appears to be a promising option in carefully selected patients with CLBP associated with the Modic changes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Transforaminal Epiduroscopic Basivertebral Nerve Laser Ablation for Chronic Low Back Pain Associated with Modic Changes: A Preliminary Open-Label Study

Kim

Adsul

Yudoyono

et al. 2018

Pain Research and Management

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“…12 Another challenging fact is that discogenic pain may only be axial in nature; studies have shown a correlation between vertebral endplate (Modic) changes seen on MRI scans and LBP. 13,14…”

Section: Common Causes For Lbpmentioning

confidence: 99%

<p>Are Opioids Needed to Treat Chronic Low Back Pain? A Review of Treatment Options and Analgesics in Development</p>

Gudin¹,

Kaufman²,

Datta³

2020

JPR

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The continued prevalence of chronic low back pain (CLBP) is a testament to our lack of understanding of the potential causes, leading to significant treatment challenges. CLBP is the leading cause of years lived with disability and the fifth leading cause of disability-adjusted life-years. No single non-pharmacologic, pharmacologic, or interventional therapy has proven effective as treatment for the majority of patients with CLBP. Although non-pharmacologic therapies are generally helpful, they are often ineffective as monotherapy and many patients lack adequate access to these treatments. Noninvasive treatment measures supported by evidence include physical and chiropractic therapy, yoga, acupuncture, and non-opioid and opioid pharmacologic therapy; data suggest a moderate benefit, at most, for any of these therapies. Until our understanding of the pathophysiology and treatment of CLBP advances, clinicians must continue to utilize rational multimodal treatment protocols. Recent Centers for Disease Control and Prevention guidelines for opioid prescribing recommend that opioids not be utilized as first-line therapy and to limit the doses when possible for fear of bothersome or dangerous adverse effects. In combination with the current opioid crisis, this has caused providers to minimize or eliminate opioid therapy when treating patients with chronic pain, leaving many patients suffering despite optimal nonopioid therapies. Therefore, there remains an unmet need for effective and tolerable opioid receptor agonists for the treatment of CLBP with improved safety properties over legacy opioids. There are several such agents in development, including opioids and other agents with novel mechanisms of action. This review critiques non-pharmacologic and pharmacologic treatment modalities for CLBP and examines the potential of novel opioids and other analgesics that may be a useful addition to the treatment options for patients with chronic pain.

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“…A combination of Type 1 and 2 is often observed within the same mixed lesion. A Type 3 MC has also been described but is rare and of no apparent clinical significance [1,3,4].…”

Section: Definition Pathoanatomy and Symptomatologymentioning

confidence: 99%

New Insights Link Low-Virulent Disc Infections to the Etiology of Severe Disc Degeneration and Modic Changes

Manniche

O’Neill

2019

Future Sci. OA

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Within the last 5 years, international research collaborations including those of several research groups skilled in microbiology, immunology and pathophysiology, have identified a low-virulent intradiscal infection with the ability to provoke gradual and progressive disc degeneration, end-plate disruption, Modic changes and persistent clinical lower-back pain. Certain strains of the Propionibacterium acne bacterium seem able to invade, colonize and develop a protective biofilm inside the disc. The interaction of P. acne , disc tissues and mononuclear cells of the bone marrow are shown to trigger a relevant immunological response and an ensuing destructive inflammation of the disc and adjacent vertebrae. This process presents on MRI as Modic changes. Recent proof-of-concept data provide compelling evidence for this bacterial disc infection hypothesis.

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10 Years of Research: From Ignoring Modic Changes to Considerations Regarding Treatment and Prevention of Low-Grade Disc Infections

Cited by 14 publications

References 28 publications

Transforaminal Epiduroscopic Basivertebral Nerve Laser Ablation for Chronic Low Back Pain Associated with Modic Changes: A Preliminary Open-Label Study

Transforaminal Epiduroscopic Basivertebral Nerve Laser Ablation for Chronic Low Back Pain Associated with Modic Changes: A Preliminary Open-Label Study

<p>Are Opioids Needed to Treat Chronic Low Back Pain? A Review of Treatment Options and Analgesics in Development</p>

New Insights Link Low-Virulent Disc Infections to the Etiology of Severe Disc Degeneration and Modic Changes

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