Answer to the Editorial of J. O’Dowd and A. Casey

Albert, H

doi:10.1007/s00586-013-2914-2

Cited by 5 publications

(3 citation statements)

References 2 publications

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“…In their opinion, at the present time antibiotherapy should only be considered for patients with LBP of at least 6 months' duration, failure of conservative care, symptomatic disc herniation within the previous year and modic type 1 changes at the same level as the disc herniation. The authors of both studies agree with these proposals [3].…”

Section: Modic Changessupporting

confidence: 81%

The Michel Benoist and Robert Mulholland Yearly European Spine Journal Review: a survey of the “medical” articles in the European Spine Journal, 2013

Benoist

2013

Eur Spine J

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Section: Modic Changessupporting

confidence: 81%

The Michel Benoist and Robert Mulholland Yearly European Spine Journal Review: a survey of the “medical” articles in the European Spine Journal, 2013

Benoist

2013

Eur Spine J

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“…A recent study has suggested antibiotic treatment as an effective option for a specific subgroup of patients with Modic type 1 changes [9]. Significant controversy has followed, with a number of authors raising concerns about the methodology and conclusion of that study [41][42][43][44][45][46][47][48][49][50][51][52]. Within the restrictions of our specimen size, and our study being a bone micro-architecture and remodelling study, not aimed at investigating bacterial infection, our histological slides of the bone biopsies (H&E stained) did not show associated oedema and no cellular infiltrate to indicate overt inflammation.…”

Section: Discussionmentioning

confidence: 99%

“…However, the material analysed in the present study included bone biopsies only, and not intervertebral disc which may contain bacteria and show inflammation. This remains a controversial topic, in need of further research as suggested by numerous letters to this journal [41][42][43][44][45][46][47][48][49][50][51][52]. Hence, evidence supporting the biomechanical and biochemical hypotheses is still not sufficient, and it remains unclear how they may play a synergistic role in the development of Modic changes in the human body [3].…”

Section: Discussionmentioning

confidence: 99%

Modic (endplate) changes in the lumbar spine: bone micro-architecture and remodelling

et al. 2014

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Purpose In the literature, inter-vertebral MRI signal intensity changes (Modic changes) were associated with corresponding histological observations on endplate biopsies. However, tissue-level studies were limited. No quantitative histomorphometric study on bone biopsies has yet been conducted for Modic changes. The aim of this study was to characterise the bone micro-architectural parameters and bone remodelling indices associated with Modic changes. Methods Forty patients suffering from disabling low back pain, undergoing elective spinal surgery, and exhibiting Modic changes on MRI (Modic 1, n = 9; Modic 2, n = 25; Modic 3, n = 6), had a transpedicular vertebral body biopsy taken of subchondral bone. Biopsies were first examined by micro-CT, for 3D morphometric analysis of bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular separation, trabecular number, and structure model index. Then, samples underwent histological analysis, for determination of bone remodelling indices: osteoid surface to bone surface ratio (OS/BS), eroded surface to bone surface (ES/BS) and osteoid surface to eroded surface ratio (OS/ES). Results Micro-CT analysis revealed significantly higher BV/TV (up to 70 % increase, p \ 0.01) and Tb.Th (up to ?57 %, p \ 0.01) in Modic 3 biopsies, compared to Modic 1 and 2. Histological analysis showed significantly lower OS/BS in Modic 2 biopsies (more than 28 % decrease, p \ 0.05) compared to 1 and 3. ES/BS progressively decreased from Modic 1 to 2 to 3, whereas OS/ES progressively increased with significantly higher values in Modic 3 (up to 159 % increase, p \ 0.05) than in Modic 1 and 2. Conclusions Significant differences were found in bone micro-architectural parameters and remodelling indices among Modic types. Modic 1 biopsies had evidence of highest bone turnover, possibly due to an inflammatory process; Modic 2 biopsies were consistent with a reduced bone formation/remodelling stage; Modic 3 biopsies suggested a more stable sclerotic phase, with significantly increased BV/TV and Tb.Th compared to Modic 1 and 2, linked to increased bone formation and reduced resorption.

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Overview: the role of Propionibacterium acnes in nonpyogenic intervertebral discs

Chen

Cao

Zhou

et al. 2016

International Orthopaedics (SICOT)

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Propionibacterium acnes (P. acnes), an important opportunistic anaerobic Gram-positive bacterium, causes bone and joint infections, discitis and spondylodiscitis. Accumulated evidence suggested that this microbe can colonise inside intervertebral discs without causing symptoms of discitis. Epidemiological investigation shows that the prevalence ranges from 13 % to 44 %. Furthermore, colonisation by P. acnes inside nonpyogenic intervertebral discs is thought to be one pathogen causing sciatica, Modic changes and nonspecific low back pain. Specially, patients can attain significant relief of low back pain, amelioration of Modic changes and alleviation of sciatica after antibiotic therapy, indicating the role of P. acnes in these pathological changes. However, until now, there were hypotheses only to explain problems such as how P. acnes access intervertebral discs and what the exact pathological mechanism it employs during its latent infection period. In addition, research regarding diagnostic procedures and treatment strategies were also rare. Overall, the prevalence and possible pathological role that P. acnes plays inside nonpyogenic intervertebral discs is summarised in this paper.

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Answer to the Editorial of J. O’Dowd and A. Casey

Cited by 5 publications

References 2 publications

The Michel Benoist and Robert Mulholland Yearly European Spine Journal Review: a survey of the “medical” articles in the European Spine Journal, 2013

The Michel Benoist and Robert Mulholland Yearly European Spine Journal Review: a survey of the “medical” articles in the European Spine Journal, 2013

Modic (endplate) changes in the lumbar spine: bone micro-architecture and remodelling

Overview: the role of Propionibacterium acnes in nonpyogenic intervertebral discs

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