Modic changes: Difference between revisions

From Wikipedia, the free encyclopedia
Browse history interactively
← Previous editNext edit →
Content deleted Content added
VisualWikitext
Partial add of causes for modic changes
Add to causes
Line 29: Line 29:
===Bacteria as a cause===
===Bacteria as a cause===
The bacterial cause is where the development of Modic change is due to an infection in the adjacent disc. A tear in the outer fibers of a disc may well initiate this infection. A disc herniation will result in a new local capillarization around the extruded material as the body attempts to remove the extruded material and inflammation with macrophages which are present in abundance.<ref>{{cite journal |last1=LINDBLOM |first1=K |last2=HULTQVIST |first2=G |title=Absorption of protruded disc tissue. |journal=The Journal of bone and joint surgery. American volume |date=July 1950 |volume=32-A |issue=3 |pages=557-60 |pmid=15428478}}</ref><ref>{{cite journal |last1=Hirabayashi |first1=S |last2=Kumano |first2=K |last3=Tsuiki |first3=T |last4=Eguchi |first4=M |last5=Ikeda |first5=S |title=A Dorsally Displaced Free Fragment of Lumbar Disc Herniation and Its Interesting Histologic Findings: A Case Report |journal=Spine |date=November 1990 |volume=15 |issue=11 |pages=1231–1233 |doi=10.1097/00007632-199011010-00026}}</ref><ref>{{cite journal |last1=Ito |first1=Takui |last2=Yamada |first2=Mitsunori |last3=Ikuta |first3=Fusahiro |last4=Fukuda |first4=Takeaki |last5=Hoshi |first5=Shin-ichi |last6=Kawaji |first6=Youichi |last7=Uchiyama |first7=Seiji |last8=Homma |first8=Takao |last9=Takahashi |first9=Hideaki E. |title=Histologic Evidence of Absorption of Sequestration-Type Herniated Disc: |journal=Spine |date=January 1996 |volume=21 |issue=2 |pages=230–234 |doi=10.1097/00007632-199601150-00014}}</ref><ref>{{cite journal |last1=Doita |first1=Minoru |last2=Kanatani |first2=Takako |last3=Harada |first3=Toshihiko |last4=Mizuno |first4=Kosaku |title=Immunohistologic Study of the Ruptured Intervertebral Disc of the Lumbar Spine: |journal=Spine |date=January 1996 |volume=21 |issue=2 |pages=235–241 |doi=10.1097/00007632-199601150-00015}}</ref><ref>{{cite journal |last1=Grönblad |first1=Mats |last2=Virri |first2=Johanna |last3=Tolonen |first3=Jukka |last4=Seitsalo |first4=Seppo |last5=Kääpä |first5=Eeva |last6=Kankare |first6=Jyrki |last7=Myllynen |first7=Pertti |last8=Karaharju |first8=Erkki O. |title=A Controlled Immunohistochemical Study of Inflammatory Cells in Disc Herniation Tissue: |journal=SPINE |date=December 1994 |volume=19 |issue=24 |pages=2744–2751 |doi=10.1097/00007632-199412150-00002}}</ref>
The bacterial cause is where the development of Modic change is due to an infection in the adjacent disc. A tear in the outer fibers of a disc may well initiate this infection. A disc herniation will result in a new local capillarization around the extruded material as the body attempts to remove the extruded material and inflammation with macrophages which are present in abundance.<ref>{{cite journal |last1=LINDBLOM |first1=K |last2=HULTQVIST |first2=G |title=Absorption of protruded disc tissue. |journal=The Journal of bone and joint surgery. American volume |date=July 1950 |volume=32-A |issue=3 |pages=557-60 |pmid=15428478}}</ref><ref>{{cite journal |last1=Hirabayashi |first1=S |last2=Kumano |first2=K |last3=Tsuiki |first3=T |last4=Eguchi |first4=M |last5=Ikeda |first5=S |title=A Dorsally Displaced Free Fragment of Lumbar Disc Herniation and Its Interesting Histologic Findings: A Case Report |journal=Spine |date=November 1990 |volume=15 |issue=11 |pages=1231–1233 |doi=10.1097/00007632-199011010-00026}}</ref><ref>{{cite journal |last1=Ito |first1=Takui |last2=Yamada |first2=Mitsunori |last3=Ikuta |first3=Fusahiro |last4=Fukuda |first4=Takeaki |last5=Hoshi |first5=Shin-ichi |last6=Kawaji |first6=Youichi |last7=Uchiyama |first7=Seiji |last8=Homma |first8=Takao |last9=Takahashi |first9=Hideaki E. |title=Histologic Evidence of Absorption of Sequestration-Type Herniated Disc: |journal=Spine |date=January 1996 |volume=21 |issue=2 |pages=230–234 |doi=10.1097/00007632-199601150-00014}}</ref><ref>{{cite journal |last1=Doita |first1=Minoru |last2=Kanatani |first2=Takako |last3=Harada |first3=Toshihiko |last4=Mizuno |first4=Kosaku |title=Immunohistologic Study of the Ruptured Intervertebral Disc of the Lumbar Spine: |journal=Spine |date=January 1996 |volume=21 |issue=2 |pages=235–241 |doi=10.1097/00007632-199601150-00015}}</ref><ref>{{cite journal |last1=Grönblad |first1=Mats |last2=Virri |first2=Johanna |last3=Tolonen |first3=Jukka |last4=Seitsalo |first4=Seppo |last5=Kääpä |first5=Eeva |last6=Kankare |first6=Jyrki |last7=Myllynen |first7=Pertti |last8=Karaharju |first8=Erkki O. |title=A Controlled Immunohistochemical Study of Inflammatory Cells in Disc Herniation Tissue: |journal=SPINE |date=December 1994 |volume=19 |issue=24 |pages=2744–2751 |doi=10.1097/00007632-199412150-00002}}</ref>
The mucous membrane of the gums is slightly damaged during ordinary tooth brushing, and anaerobic bacteria Propionibacterium Acne’s type 2 from the mouth enters the bloodstream.<ref>{{cite journal |last1=Bhanji |first1=S |last2=Williams |first2=B |last3=Sheller |first3=B |last4=Elwood |first4=T |last5=Mancl |first5=L |title=Transient bacteremia induced by toothbrushing a comparison of the Sonicare toothbrush with a conventional toothbrush. |journal=Pediatric dentistry |date=July 2002 |volume=24 |issue=4 |pages=295-9 |pmid=12212870}}</ref><ref>{{cite journal |doi=10.1007/s002469900103}}</ref><ref>{{cite journal |last1=Crock |first1=HV |title=Internal disc disruption. A challenge to disc prolapse fifty years on. |journal=Spine |date=July 1986 |volume=11 |issue=6 |pages=650-3 |pmid=3787337}}</ref>

The anaerobic bacteria can enter the disc through the breach, causing a low virulent and slowly developing infection. Since the disc is an avascular structure, it is an ideal environment for the growth of anaerobic bacteria. Propionibacterium acnes bacteria secrete propionic acid, which can dissolve fatty bone marrow and bone. Therefore, it was hypothesized that diffusion of propionic acid from the disc into the vertebrae results in bone oedema, i.e. Modic changes.

The first study by Stirling and Lambert found Propionibacterium acnes in the extruded disc material in patients undergoing surgery<ref>{{cite journal |last1=Stirling |first1=Alistair |last2=Worthington |first2=Tony |last3=Rafiq |first3=Mohammed |last4=Lambert |first4=Peter A |last5=Elliott |first5=Tom SJ |title=Association between sciatica and Propionibacterium acnes |journal=The Lancet |date=June 2001 |volume=357 |issue=9273 |pages=2024–2025 |doi=10.1016/S0140-6736(00)05109-6}}</ref> inspired the bacterial theory<ref>{{cite journal |last1=Albert |first1=H.B. |last2=Kjaer |first2=P. |last3=Jensen |first3=T.S. |last4=Sorensen |first4=J.S. |last5=Bendix |first5=T. |last6=Manniche |first6=Claus |title=Modic changes, possible causes and relation to low back pain |journal=Medical Hypotheses |date=January 2008 |volume=70 |issue=2 |pages=361–368 |doi=10.1016/j.mehy.2007.05.014}}</ref>. The discovery has led to many studies trying to identify bacteria in the disc material. The methods used in the studies to determine the presence of bacteria vary significantly from very primitive methods such as simple culturing to highly sophisticated methods, where independent research groups utilizing staining techniques with fluorescence in situ hybridization were able to visualize bacteria from an ongoing infection as well as associated inflammatory cells. These studies were carried out in real time and therefore demonstrated an ongoing bacterial infection.<ref>{{cite journal |last1=Capoor |first1=Manu N. |last2=Ruzicka |first2=Filip |last3=Schmitz |first3=Jonathan E. |last4=James |first4=Garth A. |last5=Machackova |first5=Tana |last6=Jancalek |first6=Radim |last7=Smrcka |first7=Martin |last8=Lipina |first8=Radim |last9=Ahmed |first9=Fahad S. |last10=Alamin |first10=Todd F. |last11=Anand |first11=Neel |last12=Baird |first12=John C. |last13=Bhatia |first13=Nitin |last14=Demir-Deviren |first14=Sibel |last15=Eastlack |first15=Robert K. |last16=Fisher |first16=Steve |last17=Garfin |first17=Steven R. |last18=Gogia |first18=Jaspaul S. |last19=Gokaslan |first19=Ziya L. |last20=Kuo |first20=Calvin C. |last21=Lee |first21=Yu-Po |last22=Mavrommatis |first22=Konstantinos |last23=Michu |first23=Elleni |last24=Noskova |first24=Hana |last25=Raz |first25=Assaf |last26=Sana |first26=Jiri |last27=Shamie |first27=A. Nick |last28=Stewart |first28=Philip S. |last29=Stonemetz |first29=Jerry L. |last30=Wang |first30=Jeffrey C. |last31=Witham |first31=Timothy F. |last32=Coscia |first32=Michael F. |last33=Birkenmaier |first33=Christof |last34=Fischetti |first34=Vincent A. |last35=Slaby |first35=Ondrej |title=Propionibacterium acnes biofilm is present in intervertebral discs of patients undergoing microdiscectomy |journal=PLOS ONE |date=3 April 2017 |volume=12 |issue=4 |pages=e0174518 |doi=10.1371/journal.pone.0174518}}</ref><ref>{{cite journal |last1=Ohrt-Nissen |first1=Søren |last2=Fritz |first2=Blaine G. |last3=Walbom |first3=Jonas |last4=Kragh |first4=Kasper N. |last5=Bjarnsholt |first5=Thomas |last6=Dahl |first6=Benny |last7=Manniche |first7=Claus |title=Bacterial biofilms: a possible mechanism for chronic infection in patients with lumbar disc herniation - a prospective proof-of-concept study using fluorescence in situ hybridization |journal=APMIS |date=May 2018 |volume=126 |issue=5 |pages=440–447 |doi=10.1111/apm.12841}}</ref> The results of these studies have been reproduced in several systematic reviews, concluding that 30-34 % of patients with a disc herniation have bacteria in the extruded disc material. <ref>{{cite journal |last1=Urquhart |first1=Donna M |last2=Zheng |first2=Yiliang |last3=Cheng |first3=Allen C |last4=Rosenfeld |first4=Jeffrey V |last5=Chan |first5=Patrick |last6=Liew |first6=Susan |last7=Hussain |first7=Sultana Monira |last8=Cicuttini |first8=Flavia M |title=Could low grade bacterial infection contribute to low back pain? A systematic review |journal=BMC Medicine |date=December 2015 |volume=13 |issue=1 |pages=13 |doi=10.1186/s12916-015-0267-x}}</ref> <ref>{{cite journal |last1=Ganko |first1=Renata |last2=Rao |first2=Prashanth J. |last3=Phan |first3=Kevin |last4=Mobbs |first4=Ralph J. |title=Can Bacterial Infection by Low Virulent Organisms Be a Plausible Cause for Symptomatic Disc Degeneration? A Systematic Review: |journal=Spine |date=May 2015 |volume=40 |issue=10 |pages=E587–E592 |doi=10.1097/BRS.0000000000000832}}</ref> <ref>{{cite journal |doi=10.1016/j.spinee.2021.02.013}}</ref>.




Revision as of 15:02, 10 June 2022

Modic changes are pathological changes in the bones of the spine, the vertebrae. These changes are situated in both the body of the vertebrae and in the end plate of the neighboring disc. Clinically, Modic Changes are often associated with constant lower back pain during the day, with peak pain occurring during the night and in the morning, coupled with back stiffness.[1][2]

Modic changes have been observed in approximately 6 % of the general adult population regardless of ethnicity.[3][4][5][6] Modic changes are rare in children and young adults. From the age of 25 to 40 years, there is a steep increase in their prevalence, which levels out about 40 years of age and is stable until 80+ years.[7] Modic changes are estimated to affect approximately 349 million of the adult population worldwide.[July 2021 est.][8]

Modic changes is a descriptive term used by radiologists in MRI evaluations. Conventional treatment including physiotherapy, chiropractic, acupuncture, and exercise for back pain, are ineffective in treating Modic changes. Conversely, long term antibiotic treatment has been shown to be an effective treatment if done effectively.

Signs and Symptomps

Several studies have shown a relationship between Modic changes in the spinal vertebrae and pain in the lower back.

Long term chronic pain

The last decade of studies on Modic changes have shown that Modic changes are associated with many treatment-resistant pain episodes and may result in patients entering a state of chronic low back pain. On average, individuals with Modic changes have had chronic pain for longer than individuals suffering from non-Modic changes back pain.[9][10]

Nightly Pain

Peak pain tends to occur late at night and morning and often late-night pain often results in poor and interrupted sleep.[11][12]

Morning pain and stiffness

Many individuals suffering from Modic changes, tend to have a high degree of morning stiffness in the back. The duration of the stiffness in the morning also tends to be longer compared to individuals with no Modic changes.[13][14]

Pain with lumbar hyperextension

Individuals with Modic changes experience exacerbation of pain when performing a hyperextension of the back.[15][16] A hyperextension of the back is the equivalent of performing an excessive backward bending of the back beyond its natural position.

Causes of back pain

Modic changes are a non-specific pathoanatomical marker observed on an MRI scan. For example, high blood pressure or high body temperature can be markers of several diseases. In 2008 the first hypothesis suggesting three possible pathogenetic reasons for Modic changes was published, a bacterial, a mechanical, and a rheumatological cause.[17]

Bacteria as a cause

The bacterial cause is where the development of Modic change is due to an infection in the adjacent disc. A tear in the outer fibers of a disc may well initiate this infection. A disc herniation will result in a new local capillarization around the extruded material as the body attempts to remove the extruded material and inflammation with macrophages which are present in abundance.[18][19][20][21][22] The mucous membrane of the gums is slightly damaged during ordinary tooth brushing, and anaerobic bacteria Propionibacterium Acne’s type 2 from the mouth enters the bloodstream.[23][24][25]

The anaerobic bacteria can enter the disc through the breach, causing a low virulent and slowly developing infection. Since the disc is an avascular structure, it is an ideal environment for the growth of anaerobic bacteria. Propionibacterium acnes bacteria secrete propionic acid, which can dissolve fatty bone marrow and bone. Therefore, it was hypothesized that diffusion of propionic acid from the disc into the vertebrae results in bone oedema, i.e. Modic changes.

The first study by Stirling and Lambert found Propionibacterium acnes in the extruded disc material in patients undergoing surgery[26] inspired the bacterial theory[27]. The discovery has led to many studies trying to identify bacteria in the disc material. The methods used in the studies to determine the presence of bacteria vary significantly from very primitive methods such as simple culturing to highly sophisticated methods, where independent research groups utilizing staining techniques with fluorescence in situ hybridization were able to visualize bacteria from an ongoing infection as well as associated inflammatory cells. These studies were carried out in real time and therefore demonstrated an ongoing bacterial infection.[28][29] The results of these studies have been reproduced in several systematic reviews, concluding that 30-34 % of patients with a disc herniation have bacteria in the extruded disc material. [30] [31] [32].


Diagnosing modic changes

Modic changes are characterized on MRI (magnetic resonance imaging). The 3 Modic classifications were first described and defined by Dr. Michael Modic in 1988.

Normal bone contains internal scaffolding, called trabeculae. Red bone marrow, which produces blood cells, is located in the hollows between the trabeculae.

  • In Modic type 1 there is vascular development in the vertebral body, with findings of inflammation and edema, but no trabecular damage or marrow changes.
  • In Modic type 2 there are changes in bone marrow, with fatty replacement of formerly red, cellular marrow normally seen there. With Modic type 2 changes the marrow is substituted by visceral fat, the same kind of fat we have on our hips and bellies.
  • Modic Changes type 3 are less common, with fractures of the trabecular bone, along with trabecular shortening and widening.

Modic changes have been observed in dogs.[33]

Modic changes and pain

Many studies[which?] have examined the relationship between Modic changes in the vertebrae in the spine and pain in the lower back. There are inconclusive correlation between having Modic changes and experiencing pain in the lower back.

Studies[which?] have shown that patients with Modic changes are rather different from other patients with normal back pain. For example, 75 –80 % of patients with Modic changes have constant pain, which means they do not ever have a pain-free moment day or night. There might be fluctuations in the intensity, but no break from the pain.

Treatment

It is difficult to treat patients with Modic changes. Treatment that normally cures or help patients with normal back pain does not have effect on Modic changes or pain from Modic changes.

The recommended treatment for long lasting pain in the lower back is exercises, normally aided by the instruction of a qualified clinician. This is often followed by muscle strengthening and fitness training. This treatment does help the vast majority of normal back pain patients. But studies[which?] have shown that patients with Modic changes showed much higher pain score than patients with normal back pain, and most importantly that their pain increased with training. Other recent studies cited state no clinical difference between load reduction and rest or doing physio in relation to management or improvement of the condition. [34]

Research

The following section is controversial [35] with concerns over methodology and also potential conflicts of interest, in that some of the researchers are associated with a company which certifies clinicians to diagnose the condition for £200. It is true that a study has been published, and results are interesting. However, spinal clinicians and researchers are agreed that further studies are needed, specifically fully blinded randomised controlled trials, to confirm or refute claims made in the published study. At this stage patients with low back pain should not consent to anti-biotic treatment without proper assessment and investigation under the care of a qualified spine surgeon or physician.

Scientist Hanne Albert at a large back center in Europe, the Spine Centre of Southern Denmark led by Professor Claus Manniche, performed studies that have showed that 80% of patients with Modic changes type 1 are cured or much improved after a cheap and simple antibiotic treatment.[36]

However, a more recent double blind, placebo-controlled, multicenter study from 2019 shows no evidence for the effect of antibiotics on back pain with Modic changes.[37]

References

  1. ^ Jensen, Tue Secher; Karppinen, Jaro; Sorensen, Joan S.; Niinimäki, Jaakko; Leboeuf-Yde, Charlotte (November 2008). "Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain". European Spine Journal. 17 (11): 1407–1422. doi:10.1007/s00586-008-0770-2. PMC 2583186. PMID 18787845.
  2. ^ Arnbak, Bodil; Jurik, Anne G.; Jensen, Tue S.; Manniche, Claus (February 2018). "Association Between Inflammatory Back Pain Characteristics and Magnetic Resonance Imaging Findings in the Spine and Sacroiliac Joints". Arthritis Care & Research. 70 (2): 244–251. doi:10.1002/acr.23259. PMID 28426912. S2CID 21199975.
  3. ^ Mok, Florence P.S.; Samartzis, Dino; Karppinen, Jaro; Fong, Daniel Y.T.; Luk, Keith D.K.; Cheung, Kenneth M.C. (January 2016). "Modic changes of the lumbar spine: prevalence, risk factors, and association with disc degeneration and low back pain in a large-scale population-based cohort". The Spine Journal. 16 (1): 32–41. doi:10.1016/j.spinee.2015.09.060. PMID 26456851.
  4. ^ Kuisma, Mari; Karppinen, Jaro; Niinimäki, Jaakko; Ojala, Risto; Haapea, Marianne; Heliövaara, Markku; Korpelainen, Raija; Taimela, Simo; Natri, Antero; Tervonen, Osmo (May 2007). "Modic Changes in Endplates of Lumbar Vertebral Bodies: Prevalence and Association With Low Back and Sciatic Pain Among Middle-Aged Male Workers". Spine. 32 (10): 1116–1122. doi:10.1097/01.brs.0000261561.12944.ff. PMID 17471095. S2CID 37327051.
  5. ^ Jensen, Tue Secher; Karppinen, Jaro; Sorensen, Joan S.; Niinimäki, Jaakko; Leboeuf-Yde, Charlotte (November 2008). "Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain". European Spine Journal. 17 (11): 1407–1422. doi:10.1007/s00586-008-0770-2. PMC 2583186. PMID 18787845.
  6. ^ Kjaer, Per; Korsholm, Lars; Bendix, Tom; Sorensen, Joan S.; Leboeuf-Yde, Charlotte (September 2006). "Modic changes and their associations with clinical findings". European Spine Journal. 15 (9): 1312–1319. doi:10.1007/s00586-006-0185-x. PMC 2438570. PMID 16896838.
  7. ^ Albert, Hanne B.; Briggs, Andrew M.; Kent, Peter; Byrhagen, Andreas; Hansen, Christian; Kjaergaard, Karina (August 2011). "The prevalence of MRI-defined spinal pathoanatomies and their association with Modic changes in individuals seeking care for low back pain". European Spine Journal. 20 (8): 1355–1362. doi:10.1007/s00586-011-1794-6. PMC 3175840. PMID 21544595.
  8. ^ "World". The World Factbook. Central Intelligence Agency. 26 May 2022. Retrieved 6 June 2022.
  9. ^ Bailly, F.; Maigne, J.-Y.; Genevay, S.; Marty, M.; Gandjbakhch, F.; Rozenberg, S.; Foltz, V. (March 2014). "Inflammatory pain pattern and pain with lumbar extension associated with Modic 1 changes on MRI: a prospective case–control study of 120 patients". European Spine Journal. 23 (3): 493–497. doi:10.1007/s00586-013-3036-6.
  10. ^ Arnbak, Bodil; Jurik, Anne G.; Jensen, Tue S.; Manniche, Claus (February 2018). "Association Between Inflammatory Back Pain Characteristics and Magnetic Resonance Imaging Findings in the Spine and Sacroiliac Joints". Arthritis Care & Research. 70 (2): 244–251. doi:10.1002/acr.23259.
  11. ^ Bailly, F.; Maigne, J.-Y.; Genevay, S.; Marty, M.; Gandjbakhch, F.; Rozenberg, S.; Foltz, V. (March 2014). "Inflammatory pain pattern and pain with lumbar extension associated with Modic 1 changes on MRI: a prospective case–control study of 120 patients". European Spine Journal. 23 (3): 493–497. doi:10.1007/s00586-013-3036-6.
  12. ^ Arnbak, Bodil; Jurik, Anne G.; Jensen, Tue S.; Manniche, Claus (February 2018). "Association Between Inflammatory Back Pain Characteristics and Magnetic Resonance Imaging Findings in the Spine and Sacroiliac Joints". Arthritis Care & Research. 70 (2): 244–251. doi:10.1002/acr.23259.
  13. ^ Bailly, F.; Maigne, J.-Y.; Genevay, S.; Marty, M.; Gandjbakhch, F.; Rozenberg, S.; Foltz, V. (March 2014). "Inflammatory pain pattern and pain with lumbar extension associated with Modic 1 changes on MRI: a prospective case–control study of 120 patients". European Spine Journal. 23 (3): 493–497. doi:10.1007/s00586-013-3036-6.
  14. ^ Arnbak, Bodil; Jurik, Anne G.; Jensen, Tue S.; Manniche, Claus (February 2018). "Association Between Inflammatory Back Pain Characteristics and Magnetic Resonance Imaging Findings in the Spine and Sacroiliac Joints". Arthritis Care & Research. 70 (2): 244–251. doi:10.1002/acr.23259.
  15. ^ Bailly, F.; Maigne, J.-Y.; Genevay, S.; Marty, M.; Gandjbakhch, F.; Rozenberg, S.; Foltz, V. (March 2014). "Inflammatory pain pattern and pain with lumbar extension associated with Modic 1 changes on MRI: a prospective case–control study of 120 patients". European Spine Journal. 23 (3): 493–497. doi:10.1007/s00586-013-3036-6.
  16. ^ Arnbak, Bodil; Jurik, Anne G.; Jensen, Tue S.; Manniche, Claus (February 2018). "Association Between Inflammatory Back Pain Characteristics and Magnetic Resonance Imaging Findings in the Spine and Sacroiliac Joints". Arthritis Care & Research. 70 (2): 244–251. doi:10.1002/acr.23259.
  17. ^ Albert, H.B.; Kjaer, P.; Jensen, T.S.; Sorensen, J.S.; Bendix, T.; Manniche, Claus (January 2008). "Modic changes, possible causes and relation to low back pain". Medical Hypotheses. 70 (2): 361–368. doi:10.1016/j.mehy.2007.05.014.
  18. ^ LINDBLOM, K; HULTQVIST, G (July 1950). "Absorption of protruded disc tissue". The Journal of bone and joint surgery. American volume. 32-A (3): 557–60. PMID 15428478.
  19. ^ Hirabayashi, S; Kumano, K; Tsuiki, T; Eguchi, M; Ikeda, S (November 1990). "A Dorsally Displaced Free Fragment of Lumbar Disc Herniation and Its Interesting Histologic Findings: A Case Report". Spine. 15 (11): 1231–1233. doi:10.1097/00007632-199011010-00026.
  20. ^ Ito, Takui; Yamada, Mitsunori; Ikuta, Fusahiro; Fukuda, Takeaki; Hoshi, Shin-ichi; Kawaji, Youichi; Uchiyama, Seiji; Homma, Takao; Takahashi, Hideaki E. (January 1996). "Histologic Evidence of Absorption of Sequestration-Type Herniated Disc:". Spine. 21 (2): 230–234. doi:10.1097/00007632-199601150-00014.
  21. ^ Doita, Minoru; Kanatani, Takako; Harada, Toshihiko; Mizuno, Kosaku (January 1996). "Immunohistologic Study of the Ruptured Intervertebral Disc of the Lumbar Spine:". Spine. 21 (2): 235–241. doi:10.1097/00007632-199601150-00015.
  22. ^ Grönblad, Mats; Virri, Johanna; Tolonen, Jukka; Seitsalo, Seppo; Kääpä, Eeva; Kankare, Jyrki; Myllynen, Pertti; Karaharju, Erkki O. (December 1994). "A Controlled Immunohistochemical Study of Inflammatory Cells in Disc Herniation Tissue:". SPINE. 19 (24): 2744–2751. doi:10.1097/00007632-199412150-00002.
  23. ^ Bhanji, S; Williams, B; Sheller, B; Elwood, T; Mancl, L (July 2002). "Transient bacteremia induced by toothbrushing a comparison of the Sonicare toothbrush with a conventional toothbrush". Pediatric dentistry. 24 (4): 295–9. PMID 12212870.
  24. ^ . doi:10.1007/s002469900103. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  25. ^ Crock, HV (July 1986). "Internal disc disruption. A challenge to disc prolapse fifty years on". Spine. 11 (6): 650–3. PMID 3787337.
  26. ^ Stirling, Alistair; Worthington, Tony; Rafiq, Mohammed; Lambert, Peter A; Elliott, Tom SJ (June 2001). "Association between sciatica and Propionibacterium acnes". The Lancet. 357 (9273): 2024–2025. doi:10.1016/S0140-6736(00)05109-6.
  27. ^ Albert, H.B.; Kjaer, P.; Jensen, T.S.; Sorensen, J.S.; Bendix, T.; Manniche, Claus (January 2008). "Modic changes, possible causes and relation to low back pain". Medical Hypotheses. 70 (2): 361–368. doi:10.1016/j.mehy.2007.05.014.
  28. ^ Capoor, Manu N.; Ruzicka, Filip; Schmitz, Jonathan E.; James, Garth A.; Machackova, Tana; Jancalek, Radim; Smrcka, Martin; Lipina, Radim; Ahmed, Fahad S.; Alamin, Todd F.; Anand, Neel; Baird, John C.; Bhatia, Nitin; Demir-Deviren, Sibel; Eastlack, Robert K.; Fisher, Steve; Garfin, Steven R.; Gogia, Jaspaul S.; Gokaslan, Ziya L.; Kuo, Calvin C.; Lee, Yu-Po; Mavrommatis, Konstantinos; Michu, Elleni; Noskova, Hana; Raz, Assaf; Sana, Jiri; Shamie, A. Nick; Stewart, Philip S.; Stonemetz, Jerry L.; Wang, Jeffrey C.; Witham, Timothy F.; Coscia, Michael F.; Birkenmaier, Christof; Fischetti, Vincent A.; Slaby, Ondrej (3 April 2017). "Propionibacterium acnes biofilm is present in intervertebral discs of patients undergoing microdiscectomy". PLOS ONE. 12 (4): e0174518. doi:10.1371/journal.pone.0174518.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  29. ^ Ohrt-Nissen, Søren; Fritz, Blaine G.; Walbom, Jonas; Kragh, Kasper N.; Bjarnsholt, Thomas; Dahl, Benny; Manniche, Claus (May 2018). "Bacterial biofilms: a possible mechanism for chronic infection in patients with lumbar disc herniation - a prospective proof-of-concept study using fluorescence in situ hybridization". APMIS. 126 (5): 440–447. doi:10.1111/apm.12841.
  30. ^ Urquhart, Donna M; Zheng, Yiliang; Cheng, Allen C; Rosenfeld, Jeffrey V; Chan, Patrick; Liew, Susan; Hussain, Sultana Monira; Cicuttini, Flavia M (December 2015). "Could low grade bacterial infection contribute to low back pain? A systematic review". BMC Medicine. 13 (1): 13. doi:10.1186/s12916-015-0267-x.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  31. ^ Ganko, Renata; Rao, Prashanth J.; Phan, Kevin; Mobbs, Ralph J. (May 2015). "Can Bacterial Infection by Low Virulent Organisms Be a Plausible Cause for Symptomatic Disc Degeneration? A Systematic Review:". Spine. 40 (10): E587–E592. doi:10.1097/BRS.0000000000000832.
  32. ^ . doi:10.1016/j.spinee.2021.02.013. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  33. ^ Gendron, Doherr, Gavin; et al. (2012). "Magnetic Resonance Imaging Characterization of Vertebral Endplate Changes in the Dog". Veterinary Radiology & Ultrasound. 53 (1): 50–56. doi:10.1111/j.1740-8261.2011.01861.x. PMID 21992691.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  34. ^ Jensen, Rikke Krüger (23 September 2011). "Rehabilitation of Patients with Modic Changes in the Lumbar Spine - a Randomized Controlled Trial".
  35. ^ "Back pain breakthrough crippled by doubt". 2013-06-16.
  36. ^ Albert HB, Sorensen JS, Christensen BS, Manniche C (2013). "Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized clinical controlled trial of efficacy". European Spine Journal. 22 (4): 697–707. doi:10.1007/s00586-013-2675-y. PMC 3631045. PMID 23404353.
  37. ^ Bråten LCH (Aug 2019). "Efficacy of antibiotic treatment in patients with chronic low back pain and Modic changes (the AIM study): double blind, randomised, placebocontrolled, multicentre trial."". BMJ. 367: l5654. doi:10.1136/bmj.l5654. PMC 6812614. PMID 31619437.

Bibliography

Retrieved from "https://en.wikipedia.org/w/index.php?title=Modic_changes&oldid=1092477297"