Abstract
Introduction
Vertebral endplate changes/Modic changes (MC) are the MRI-image of inflammatory vertebral endplate damage.1 In patients with chronic back pain, the prevalence of (MC) is 40%.2 MC are most often related to general disc degeneration or herniation.3 However, in a subgroup of patients, disc infection may be involved.4,5 In one high quality RCT more than 50% of patients with persistent pain and prolapsed discs showed clinically significant improvement after treatment with a broad spectrum antibiotic at 6 Month Follow Up (6MFU).6
Material and Methods
A cohort study was established to evaluate the effect of treatment with Amoxicillin/ Clavulanic Acid for 3 months. 70 patients were treated with 1 1/2 g per day for one month followed by 3 g per day for 2 months (HighDose). Another 77 patients were treated with 2 g per day for 3 months (LowDose). The clinical profile of the included patients: referred to a secondary care outpatient Spine Centre with persistent low back pain and lumbar MC Type 1 and no effect of other non-surgical treatment forms. Main outcome measures at 6MFU: Patient's global assessment (Global), change in spinal pain intensity on a 0–10 numerical rating scale (DeltaPain) and Number of Days with Pain (DaysPain) over a 14 day period. Responders were compared with non-responders.
Results
147 patients (95 females) were included. The outcome analysis compares the treatment effect of the responders to the non-responders. Overall, 78/147; 53.01% of the patients stated a positive responder treatment effect after 6 months. DeltaPain in ‘the responder group’ at 6 months follow up was -29.96%[SD 36.2%] and in ‘the non-responder group’ 2.16% [SD 43.3%]. DaysPain decrease in ‘the responder group’ at 6MFU were 22.17% [SD 60.3], and in ‘the non-responder group’ an increase of 28.07%[SD 153.6]. Substantial side effects were noted in 17/70(24%) patients in HighDose and 12/77(16%) in LowDose patients. Minor side effects: 17/70(24%) of patients in HighDose and 14/77(18%) patients in LowDose. No difference in responderrate were seen between HighDose/ LowDose; 52.9%/53.3%.
Conclusion
The antibiotic treatment regime in this group of low back pain patients represented positive outcome results for 53% of the patients. At 6MFU clinically relevant improvements regar- ding pain intensity were obtained and numbers of days with pain was reduced by 22%. A higher number of side effects was seen using HighDose antibiotics compared with LowDose, but there was no difference in treatment efficacy.
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