Vertebral endplate (modic) changes and the treatment of back pain using antibiotics

• Vertebral endplate changes/modic changes (MC) are the MRI-images of inflammatory vertebral endplate damage that are often related to general disc degeneration. • In patients with prolonged back pain, the prevalence of MC is 40%. • In individuals with MC, more than 90% will have back pain within 1 year. • MC often causes localized pain 24/7. • Nocturnal pain is the rule rather than the exception. • New MC type 1 occurs frequently during the course of a disc herniation. • There are currently no better diagnostic methods in MC than MRI and a case story of the typical inflammatory back pain pattern and the likely presence of a disc herniation within the recent few years. • In biopsies from prolapsed disc mass, bacteria – most commonly Propionibacterium acnes of the oral cavity class – are found in at least 40% of patients. • In a MC subgroup with persistent back pain after a disc herniation and emerging MC type 1, it is relevant to consider: ‘disc infection’. • In one high quality RCT, including a subgroup of post-prolapse/MC patients with chronic pain, demonstrated clinically significant improvements in more than 50% of the patients after 3 months of treatment with a broad spectrum antibiotic. • MC type 1 are generally considered to be an important prognostic marker of a poor prognosis.