by Alan Jordan
At the Broadgate Spine & Joint Clinic we have the largest number of MAST Certified Clinicians of any clinic in the UK. We are seeing an increasing number of patients who come to our clinic in order to determine whether they are candidates for antibiotic therapy.
At Broadgate, we scrutinise our patients extremely thoroughly prior to initiating treatment. This involves identifying specific characteristics from their case history, their physical examination, and of course MRI confirmed Modic changes. The essential clinical findings related to arriving at the diagnosis of Modic has been reviewed elsewhere in this journal. All of our MRI scans are interpreted by MAST Certified Radiologists with whom we work closely.
As one would expect, the more thorough and certain clinicians are of a diagnosis, the greater the likelihood of attaining better results.
Patients suffering with longstanding disabilities and severe lower back pain who have tried every imaginable therapy are desperate to seek a solution to their problem. As our clinic is well known we have been receiving patients from all over the country who are desperate to find out whether or not they have Modic changes that could be responsible for their troubles. We also receive MRI scans via the postal service from many countries asking us to interpret their MRI scans.
However, a diagnosis must be arrived at in which the case history, the physical findings and the MRI scans must “add up” to a clear picture of Modic prior to prescribing antibiotics for a period of 3 months. AS we knew before this all began, we would be receiving patients who are indeed experiencing severe difficulties who do not demonstrate signs of Modic and must sadly inform them that we cannot offer them any meaningful treatment. This is a far from pleasant task.
A Case Study
As discussed elsewhere in this journal the average patient requires 6-8 weeks of antibiotics before they experience any improvement and that even after 3 months of antibiotics they will continue to improve for the remainder of the following year. In other words, this is a long process which makes perfect biological sense. However, as back specialists know, not everyone “fits” into the statistical averages that the large clinical trials demonstrate.
Approximately 6 weeks ago we interviewed and examined a young (mid-thirties) personal trainer who had undergone surgery for a disc herniation about 1 year ago. Initially, her results were excellent but some months thereafter a “new” pain developed deep in her lower spine that was constant, kept her awake at night, and only permitted her to work 1 day per week. After a day at the gym she had to remain in bed for three days in order to recover – not at all sustainable. Her case history and examination ticked all of the boxes, and as a post-surgical patient we knew that she was amongst those that are most likely to develop Modic changes. We anxiously awaited the results of the MRI scans. When they came back positive for Modic changes we were all delighted.
We began antibiotic treatment 6 weeks ago and she returned to the clinic for a follow-up consultation. At the initial consultation she cried out of frustration – at the follow-up consultation she cried out of joy. She had NO pain and no physical limitations. We were all astonished and delighted at the same time. It is cases like this that can make practice such an utter joy.
At Broadgate we record patient pain levels, disabilities, nr of hours with pain per day and all of the other outcome measures that were used in the groundbreaking clinical trial carried out by Dr Hanne Albert. The Case Study outlined above is one of the cases that clinicians dream about but clearly reflect the exception rather than the rule. So far, our results appear to reflect those of Dr Albert but these are early days for our clinic and proper follow-up data takes a year to obtain. We will publish the data when the time arrives.
Needless to say, we are more than pleased with our results to date, are happy with the work that we are doing and the skills that we have obtained by becoming MAST Certified Clinicians. We now have a treatment to offer a significant number of patients who had nowhere else to go just a few months ago.
