Association between sciatica andPropionibacterium acnes

• Serological test (exocellular antigen produced by gram-positive bacteria (lipid S)) to diagnose deep-seated infections caused by low virulent gram-positive microorganisms. 43 of 140 (31%)patients with sciatica tested positive.

• 36 patients with severe sciatica (MR scanning: Discogenic radiculitis) who had undergone microdiscectomy was cultured for the presence of microorganisms. 19 of these patients (53%) had positive cultures after long-term incubation. Propionibacterium acnes was isolated from 16 of the 19 (84%) positive samples.

• Microorganisms were not detected in any of the 11 gram-stained thin sections examined by direct microscopy, suggesting that they are present only in low numbers.

Alistair Stirling, Tony Worthington, Mohammed Rafiq,Peter A Lambert, Tom S J Elliott

THE LANCET • Vol 357 • June 23, 2001

Antibiotic treatment in patients with chronic low back painand vertebral bone edema (Modic type 1 changes): a double-blind

randomized clinical controlled trial of efficacy

Hanne B. Albert • Joan S. Sorensen •Berit Schiott Christensen • Claus Manniche

Eur Spine J (2013) 22:697–707DOI 10.1007/s00586-013-2675-y

H. B. Albert (&) J. S. Sorensen C. MannicheResearch Department, Spine Centre of Southern Denmark,Institute of Regional Health Services Research, LillebaeltHospital, University of Southern Denmark, Middelfart, DenmarkB. S. ChristensenDepartment of Rheumatology, Aarhus University Hospital,Aarhus, Denmark

Purpose: Modic type 1 changes/bone edema in thevertebrae are present in 6 % of the general population and35–40 % of the low back pain population. It is stronglyassociated with low back pain. The aim was to test theefficacy of antibiotic treatment in patients with chronic lowback pain ([6 months) and Modic type 1 changes (boneedema).

Modic (MRI) and three types have been identified (Types 1–3) . Type 1 involve disruption and fissuring of the endplate with regions of degeneration, regeneration,reactive bone formation, endplate edema and vascular granulation tissue

1 = endplate only, 2 = up to 25 %, 3 = up to 50 %4 = above 50 % of the vertebrae. Patients also had to haveLBP in the area from L1 to L5 with a Numerical PainRating Scale score of C6 after adding the current LBP(0–10)

The initial inclusion criteria were: •18 - 65 years, •MRI-confirmed disc herniation L3/L4 or L4/L5 or L5/S1 (6–24 months), •lower back pain of >6 months duration, •Both conservative and surgically treated patients were included,

regardless of sciatica, neuropathic pain or not.

•Dobbeltblindet (til 1 års kontrol), 162 pt, 147 (treatment questionnaires), 144 (1-year follow up)

Amox-clavulan (500 mg/125 mg), 1x3 tbl. dgl eller 2x3 tbl. I 100 dage