by Alan Jordan
I have written a number of articles on Modic changes and antibiotic treatment in the Broadgate Journal. Hopefully, these articles have helped readers understand what Modic changes are and why antibiotic treatment helps the overwhelming majority – but not all patients with Modic findings. Patients whose Modic changes are not a result of bacterial infection but rather of mechanical origin will naturally not benefit from antibiotic treatment.
We have now been treating Modic changes at our clinic since May when the major publication was presented. I personally have seen patients from Switzerland, Brazil, Holland, Scotland, Ireland, Dubai and probably several countries that I cannot recall. It has been quite an experience.
Modic patients suffer from severe – very severe – back pain. They suffer from a greater degree of disability than most of the patients that I have seen in 30 years of practice. As a rule they are desperate to find help as conventional treatments such as manipulation, injections, exercise, acupuncture and so on are of no benefit. This makes good sense of course due to the fact that these treatments would hardly be deemed as being appropriate for an underlying infection.
Before initiating a course of treatment – 3 months of antibiotics – we need to be as careful and certain of our diagnosis as possible. This involves;
- Classical case history findings
- Classical physical findings
- MRI confirmed Modic changes
Information is crucial to patients. They need to understand why the course of antibiotics must last 100 days, what they are allowed to do during their normal daily activities, expectations and so forth.
We know of course that most if not all patients will have had a disc herniation in order to develop Modic changes and that there is therefore a mechanical weakness that is also contributing towards their pain. It is literally impossible for anyone to predict what percentage of a patient’s symptoms are due to Modic changes and what percentage are due to underlying mechanical weakness.
In my opinion if the three criteria above are fulfilled then it makes good sense to embark upon a 100 day course of antibiotics.
On average, patients begin to experience relief about 8-10 weeks into treatment and this improvement continues until the end of treatment and indeed the following 9 months as well. Initially, the bacteria are killed off and the bone can then begin to heal. Bones heal rather slowly and that it why improvement continues for up to a year. In fact, it has been shown that patients improve as much following the 100 days of treatment as they due during the course of treatment. Since no two patients are identical we often see a considerable variation in the time axis of improvement.
Conclusion
Treating patients with Modic changes has been the most exciting development that I have seen during 30 years of practice. It is extremely rewarding to be able to “do” something for this patient group that has literally tried every imaginable type of treatment. We take good care to do a thorough case history, physical examination and MRI interpretation and of equal importance we take the time to explain to patients how they should carry on with their daily activities and what reasonable expectations are. In the not too distant future we will be publishing our initial results in the Broadgate Journal. We will also continue to publish articles on Modic changes in order to keep our readers updated on this most exciting topic.
