Treatment of Modic changes

Treatment of patients with Modic changes.

The first step in treatment is to identify what kind of Modic changes the patient has. There are probably three reasons for Modic changes, 1. The inflammatory / rheumatology, 2. The mechanical and 3. The bacterial. These reasons are scientifically described scientifically in paper no 1.

 1. The treatment of inflammatory / rheumatic Modic changes

There are certain types of rheumatological disease in the spine, for example a disease called Mb. Becterew. In patients who have this disease, one can very frequently observe Modic changes, and Modic changes will often be mentioned in the MR-description. These Modic changes has a very typical appearance, and it is relatively easy to distinguish them from the other forms of Modic changes. If you have any kind of rheumatologically diseases in the spine, it is important to be referred to a rheumatologist and that he / she is in charge of the treatment of this disease. 2.

2.Treatment of mechanical Modic changes.

There are certain diseases of the spine, such as a forward slippage of one vertebra relative to the adjacent vertebra (spondylolisthesis), or rotation of the vertebrae (scoliosis), and other structural diseases, which can cause Modic changes. This is probably due to a strong pull and thereby damage in the end plates; this may cause the Modic changes. These reasons are scientifically described in paper 1 and 2. In some cases, mechanical Modic changes can be treated with bio-stimulating laser. Laser cannot cure the underlying cause, such as the forward sliding of the vertebrae. But it may decrease the inflammatory process and increase bone healing so the patient experiences pain relief.

3. The treatment of bacterial Modic changes.

Modic changes can also be caused by a bacterial infection of a discus in connection with a discus herniation. It is possible to have a disc herniation without having had leg pain. Several studies have shown this cause, you can read more in the scientific paper 3,4,5,6.
To verify that a theory about occurrence of a disease is credible, it is important that it can be confirmed in animal studies. The bacterial theory is confirmed in two animal studies. A research team from China took bacteria from a person who had developed Modic changes after a discus herniation and injected these bacteria into the discs in rabbits. The experiment showed that the bacteria could cause Modic changes (see paper 7). The same has a research group in San Francisco in California also shown, and in another animal. They also took bacteria from the discus a person who had developed Modic changes after a discus herniation. These bacteria were injected in the rat’s discs. After 14 days showed MRI scans of the rats that had developed, Modic changes (see paper 8).

In January 2016, a research group published a review all the literature concerning this scientific area and wrote a so-called review. The group concludes, "Colonization of certain bacteria in the discus may be the causes of leg pain, Modic changes and lower back pain. Some patients may experience significant relief from their back pain, Modic changes disappear and leg pain disappear after antibiotic treatment "(see paper 9).

Frequently, the treatment of infection by bacteria is cured by treatment with antibiotics. The first trial with, antibiotics and very thorough patient information about behavior, in patients with bacterial Modic changes were performed at The Back Research Center in Ringe by Hanne Albert and was published in 2008. It was shown that there was a good response to treatment (see paper 10).

In 2013, Hanne Albert published the first clinically controlled studies of 162 patients. In this study, the patients were given either placebo or different doses of antibiotics, and very thorough patient information about behavior. Measurements were performed on a large number of parameters from physical function, pain, blood samples, changes in the MRI scans etc. In all of the measured parameter, it was found that there was highly significant effects of treatment (see Paper 11).

In 2015, a group of orthopedic surgeons in Iran published the second clinically controlled trial. In this clinical controlled trial, 71 patients with Modic changes after a previous herniation received either antibiotics or placebo in 100 days. The results were virtually identical to the Danish study, (see paper 12)

1. Albert HB, Kjaer P, Jensen TS, Sorensen JS, Bendix T, Manniche C Modic changes, possible causes and relation to low back pain. Med Hypotheses. 2008;70:361-8. Epub 2007 Jul 10.
2. Adams MA et al. Stress distribution s inside intervertebral discs. The effect of age an degeneration. The Journal of bone and joint surgery. British volume 1996;78:965-972.
3. Albert HB, Manniche C. Modic changes following lumbar disc herniation. Eur Spine J. 2007;16:977-82. Epub 2007 Mar 3.

4. Stirling A, Worthington T, Rafiq M et al.: Association between sciatica and
Propionebacterium acnes. Lancet 2001;357:2024-2025.

5. Albert HB, Lambert P, Rollason J, Sorensen JS, Worthington T, Pedersen MB, Nørgaard HS, Vernallis A, Busch F, Manniche S, Elliott T. Is nuclear tissue infected with bacteria following disc herniations which leads to Modic changes in the adjacent vertebrae? Eur Spine J. 2013;22:690-6. Epub 2013 Feb 10.

6. Urquhart DM, Zheng Y, Cheng AC, Rosenfeld JV, Chan P, Liew S, Hussain SM, Cicuttini FM. Could low grade bacterial infection contribute to low back pain? A systematic review. BMC Med. 2015 Jan 22;13:13. doi: 10.1186/s12916-015-0267-x. Review

7. Zhe Chen, Yuehuan Zheng,Ye Yuan, Yucheng Jiao, Jiaqi Xiao, Zezhu Zhou, and Peng Cao.Modic Changes and Disc Degeneration Caused by Inoculation of Propionibacterium acnes inside Intervertebral Discs of Rabbits: A Pilot Study. BioMed Research International, Volume 2016 (2016), Paper ID 9612437

8. Stefan Dudli, Ellen Liebenberg, Sergey Magnitsky, Steve Miller, Sibel Demir-Deviren, Jeffrey C Lotz. Propionibacterium acnes infected intervertebral discs cause vertebral bone marrow lesions consistent with Modic changes. J Orthop Res. 2016 Apr 21. doi: 10.1002/jor.23265. [Epub ahead of print]

9. Zhe Chen, Peng Cao, Zezhu Zhou, Ye Yuan, Yucheng Jiao, Yuehuan Zheng, Overview: the role of Propionibacterium acnes in nonpyogenic intervertebral discs, International Orthopaedics, pp 1-8, First online: 28 January 2016, Review Paper

10. Albert HB, Manniche C, Sorensen JS. Deleuran BW. Antibiotic treatment in patients with low-back pain associated with Modic changes Type 1 (bone oedema): a pilot study. Br J Sports Med. 2008:42:969-73. Epub 2008 Aug 21.

11. Albert HB , Sorensen JS, Christensen BS, Manniche C. Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic Type 1 changes): a double-blind randomized clinical controlled trial of efficacy. Eur Spine J. 2013;22:697-707. Epub 2013 Feb 13.

12. Mohanned A. Al-Falahi, Mohammed H. Salal, Dhiaa M. Abdul-Wahab. Antibiotic Treatment in Patients with Chronic Low Back Pain and Vertebral Bone Edema (Modic Type I Changes): A Randomized Clinical Controlled Trial of Efficacy. The Iraqui postgraduate Medical Journal vol. 13, no 13 pp 390-398, 2014.

13. Bendix T, Sorensen JS, Henriksson GA, Bolstad JE, Narvestad EK, Jensen TS. Lumbar modic changes-a comparison between findings at low- and high-field magnetic resonance imaging.Spine (Phila Pa 1976). 2012 Sep 15;37(20):1756-62. Erratum in: Spine (Phila Pa 1976). 2013 May 20;38(12):E766. 







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