, Volume 22, Issue 4, p 689
Date: 08 Mar 2013

Is low back pain after disc herniation with Modic Type 1 changes a low-grade infection?

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In this issue of the European Spine Journal we are confronted with new data concerning the significance of Modic Type 1 changes (MC I) in patients with chronic low back pain. We know from previous studies that MC I occurs six times more frequently in the low back pain population than in the general population. The reason may be of mechanical nature, but under certain circumstances low virulent infections may play a key role. The Danish group of H. B. Albert does not only demonstrate that patients with infected herniated nucleus material by anaerobic bacteria in lumbar disc herniation develop in 80 % new MC I in adjacent vertebrae, but also that those patients with low back pain and MC I after disc herniation improved highly statistically significant on all outcome measures under an antibiotic protocol. This strongly suggests one cause of low back pain in combination of MC I to be of low-grade infectious nature in case of previous disc herniation.

Since it is ethically impossible to have ...