Abstract

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

Author(s): Claus Manniche

Vertebral end-plate changes/modic changes are the MRI-image of inflammatory vertebral endplate damage, most often related to general disc degeneration. However, in a subgroup of patients disc infection may be the causal factor. In patients with prolonged back pain, the prevalence of modic changes (MC) is 40%. In most cases, nocturnal pain is the rule and MC causes highly localized pain 24/7. There are currently no better diagnostic methods than MRI and case history findings. In persistent back pain after a disc herniation and emerging MC type 1, it is relevant to consider: ‘disc infection’. Most commonly, Propionibacterium acnes is involved. Long-term antibiotics may be effective.