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Pawl R. Editorial on two chronic low back pain studies: A major change in surgical management of disc disease?. Surg Neurol Int. 2013;4:S373-4doi: 10.4103/2152-7806.120780.
Pawl, R. (2013). Editorial on two chronic low back pain studies: A major change in surgical management of disc disease?. Surgical neurology international, 4S373-4. https://doi.org/10.4103/2152-7806.120780
Pawl, Ron. "Editorial on two chronic low back pain studies: A major change in surgical management of disc disease?." Surgical neurology international vol. 4 (2013): S373-4. doi: https://doi.org/10.4103/2152-7806.120780
Pawl R. Editorial on two chronic low back pain studies: A major change in surgical management of disc disease?. Surg Neurol Int. 2013 Oct 29;4:S373-4. doi: 10.4103/2152-7806.120780. eCollection 2013. PMID: 24340235; PMCID: PMC3841939.
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Surg Neurol Int. 2013 Oct 29;4:S373-4. doi: 10.4103/2152-7806.120780. eCollection 2013.

Editorial on two chronic low back pain studies: A major change in surgical management of disc disease?.

Surgical neurology international

Ron Pawl

Affiliations

  1. Department of Neurosurgery, University of Illinois, Chicago, Illinois, USA.

PMID: 24340235 PMCID: PMC3841939 DOI: 10.4103/2152-7806.120780

Abstract

In two recent publications, the authors' hypothesis was that Modic type 1 changes seen in patients with chronic low back pain and herniated lumbar discs may be attributed to bacterial infection/inflammation. The first study showed that many herniated discs were infected with Proprionibacterium acnes, a common anaerobic skin organism, also found in sarcoidosis, and possibly, arthritic joints. In the second double-blind randomized study, 162 patients with disc herniation and Modic type 1 changes were treated with 100 days of oral Bioclavid (Amoxicillin/Clavulanic acid) vs. placebo; those treated with antibiotics improved in all dimensions (e.g., reduced chronic low back/leg pain, reduced disability). Together, the implications of these studies for spine surgeons and pain practitioners are momentous. If a few weeks of oral antibiotic treatment resolves chronic low back pain, then much currently performed spine surgery (e.g. including internal fixation/fusion), as well as chronic pain management/rehabilitation and psychological strategies may be rendered unnecessary.

Keywords: Disc disease; Modic type I changes; infection; nonsurgical; spine

References

  1. Eur Spine J. 2013 Apr;22(4):697-707 - PubMed
  2. Eur Spine J. 2013 Apr;22(4):690-6 - PubMed
  3. J Shoulder Elbow Surg. 2013 Apr;22(4):505-11 - PubMed
  4. J Invest Dermatol. 2013 Sep;133(9):2141-2 - PubMed
  5. Respir Investig. 2013 Jun;51(2):56-68 - PubMed

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