Letter to the editor concerning: “Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized controlled trial of efficacy” by Albert HB et al. Eur Spine J (2013) 22:697–707

Ahmad, Zuber; Rai, Am; Donell, Simon T.; Crawford, R. J.

doi:10.1007/s00586-013-2979-y

Cited by 6 publications

(5 citation statements)

References 7 publications

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“…This could also be the case in our study, as five dogs were treated for discospondylitis conservatively with antibiotics prior to the collection of disc material for bacterial culture. Interestingly, the topic of bacteria in IVDs causing low back pain has received considerable attention in recent years in the field of spine research in humans and has since been the subject of heated debate [ 47 – 49 ]. This debate was initiated by reports by Albert et al [ 50 ] on findings of bacteria in IVD material harvested during spinal surgery [ 51 ] and publication of a randomized clinical trial showing successful treatment of humans with chronic low back pain using long term oral antibiotics [ 52 ].…”

Section: Discussionmentioning

confidence: 99%

Pedicle screw-rod fixation: a feasible treatment for dogs with severe degenerative lumbosacral stenosis

et al. 2015

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BackgroundDegenerative lumbosacral stenosis is a common problem in large breed dogs. For severe degenerative lumbosacral stenosis, conservative treatment is often not effective and surgical intervention remains as the last treatment option. The objective of this retrospective study was to assess the middle to long term outcome of treatment of severe degenerative lumbosacral stenosis with pedicle screw-rod fixation with or without evidence of radiological discospondylitis.ResultsTwelve client-owned dogs with severe degenerative lumbosacral stenosis underwent pedicle screw-rod fixation of the lumbosacral junction. During long term follow-up, dogs were monitored by clinical evaluation, diagnostic imaging, force plate analysis, and by using questionnaires to owners.Clinical evaluation, force plate data, and responses to questionnaires completed by the owners showed resolution (n = 8) or improvement (n = 4) of clinical signs after pedicle screw-rod fixation in 12 dogs. There were no implant failures, however, no interbody vertebral bone fusion of the lumbosacral junction was observed in the follow-up period. Four dogs developed mild recurrent low back pain that could easily be controlled by pain medication and an altered exercise regime.ConclusionsPedicle screw-rod fixation offers a surgical treatment option for large breed dogs with severe degenerative lumbosacral stenosis with or without evidence of radiological discospondylitis in which no other treatment is available. Pedicle screw-rod fixation alone does not result in interbody vertebral bone fusion between L7 and S1.

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Section: Discussionmentioning

confidence: 99%

Pedicle screw-rod fixation: a feasible treatment for dogs with severe degenerative lumbosacral stenosis

et al. 2015

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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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“…Albert et al in 2013 found that MCs may have a bacterial etiology [ 18 ] and can be treated with antibiotics [ 19 ]. These findings created headlines worldwide and much debate among clinicians and researchers [ 20 – 26 ] because of a potential risk of bias, conflicting results in studies investigating a bacterial etiology [ 18 , 27 – 29 ], and the prospect of treating a large group of LBP patients with long-term high-dose antibiotics.…”

Section: Introductionmentioning

confidence: 99%

Modic changes—Their associations with low back pain and activity limitation: A systematic literature review and meta-analysis

Herlin¹,

et al. 2018

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BackgroundPrevious systematic reviews have reported positive associations between Modic changes (MCs) and low back pain (LBP), but due to their narrow scope and new primary studies, there is a need for a comprehensive systematic review. Our objectives were to investigate if MCs are associated with non-specific LBP and/or activity limitation and if such associations are modified by other factors.MethodsA protocol for this review was registered at PROSPERO prior to commencing the work (PROSPERO record: CRD42015017350). The MEDLINE, CINAHL and EMBASE databases were searched for relevant studies from first record to June 15th 2016. Prospective or retrospective cross-sectional cohort studies and case-control studies including people of all ages from general, working and clinical study populations were eligible for inclusion. Risk of bias assessment and data extraction for associations and potential modifiers were completed independently by pairs of reviewers. Meta-analysis was performed for homogeneous studies and presented as odds ratios (OR) with 95% CI.ResultsIn all, 5210 citations were identified and 31 studies were included. One study had low risk of bias. Fifteen studies (48%) reported statistically significant positive associations between MCs and LBP and one study found a statistically significant negative association. Meta-analysis performed for studies using concordant pain with provocative discography as the clinical outcome resulted in an OR of 4.01 (1.52–10.61). One of seven studies reported a statistically significant positive association between MCs and activity limitation. Lumbar disc level and disc degeneration were found to modify the association between MCs and LBP.ConclusionsThe results from this comprehensive systematic review indicate that the associations between MCs and LBP-related outcomes are inconsistent. The high risk of bias and the heterogeneity in terms of study samples, clinical outcomes and prevalence estimates of MCs and LBP may explain these findings. It is likely that new studies with low risk of bias will affect the direction and strength of these associations.

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Letter to the editor concerning: “Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized controlled trial of efficacy” by Albert HB et al. Eur Spine J (2013) 22:697–707

Cited by 6 publications

References 7 publications

Pedicle screw-rod fixation: a feasible treatment for dogs with severe degenerative lumbosacral stenosis

Pedicle screw-rod fixation: a feasible treatment for dogs with severe degenerative lumbosacral stenosis

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

Modic changes—Their associations with low back pain and activity limitation: A systematic literature review and meta-analysis

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