Modic Type I Changes

[emd123]

What are you guys doing with Modic Type I changes on MRI?
I know that pre-1980's we didn't even know about them, they Modic named them but we routinely ignored them, then someone did a study that said maybe some of these are chronic, indolent bacterial infections and you could treat some with 3 months of Augmentin, but more studies were needed, yada, yada.

Your MRI report comes back "Modic Type I endplate changes."

What's your approach?

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[lobelsteve]

Congrats. You are now aged 30. These are normal findings. Ooh look, a renal cyst, a hemangioma, and a tarlov cyst.
Just keep swimming, Dory.

 

[emd123]

Congrats. You are now aged 30. These are normal findings. Ooh look, a renal cyst, a hemangioma, and a tarlov cyst.
Just keep swimming, Dory.

So, you ignore Modic I?

 

[lobelsteve]

So, you ignore Modic I?

If axial LBP, and no other findings with concordance for their pain....
Treatment is PT, not meds or procedures.

 

[epidural man]

What are you guys doing with Modic Type I changes on MRI?
I know that pre-1980's we didn't even know about them, they Modic named them but we routinely ignored them, then someone did a study that said maybe some of these are chronic, indolent bacterial infections and you could treat some with 3 months of Augmentin, but more studies were needed, yada, yada.

Your MRI report comes back "Modic Type I endplate changes."

What's your approach?

I explained the antibiotic and infection theory to a patient (with Modic changes) once, told him it might work, told him the risks, told him I hadn't tried it before, etc.

We did Augmentin for 3 weeks - he developed a pretty bad diarrhea - so I got nervous and stopped it.

I asked our ID folks about the studies and what they thought about giving these ABX for back pain. They thought it was nuts.

 

[nvrsumr]

be greedy and get paid that $100 for an esi -magenta-

 

[NOSfan]

What are you guys doing with Modic Type I changes on MRI?
I know that pre-1980's we didn't even know about them, they Modic named them but we routinely ignored them, then someone did a study that said maybe some of these are chronic, indolent bacterial infections and you could treat some with 3 months of Augmentin, but more studies were needed, yada, yada.

Your MRI report comes back "Modic Type I endplate changes."

What's your approach?

PT, Piroxicam, Arthrotec......and have Rx Abx x 100 days in n=3 --> 80% x 2 and 100% pain relief by the lot. TIFWIW

 

[bedrock]

N of 3 is what catches my eye, particularly in this day of growing antibiotic resistance.

 

[NOSfan]

N of 3 is what catches my eye, particularly in this day of growing antibiotic resistance.

n=3 not really concerned about creating Super Bugs

Of course more data is needed regarding utilizing Abx for treatment of Modic......but who knows....many thought that PUD couldn't be cured with ABx and Dr. Barry James Marshall ended up winning the Nobel Prize

Cheers

 

[SSdoc33]

i dont just ignore the modic 1 changes, but they probably dont mean all that much. usually, if you have significant modic changes, there are degenerative changes at the corresponding disc. this might mean their pain is discogenic. if it really lights up, i think that is a significant finding. what you do about treating it is a different story. agree that PT is probably all you should do.

as far as the bacteria theory? the gut is a different place than the spine. it is not surprising (at least with what we know now), that there are a ton of bacteria swimming around your stomach, and some bad bacteria could cause an ulcer. it is tough to make that connection in the spine.

 

[NOSfan]

.......as far as the bacteria theory? the gut is a different place than the spine. it is not surprising (at least with what we know now), that there are a ton of bacteria swimming around your stomach, and some bad bacteria could cause an ulcer. it is tough to make that connection in the spine.

Thoughts on the following literature?

 

[SSdoc33]

Thoughts on the following literature?

well, you just put me 30 minutes behind today. thanks.

the articles are interesting.

there may be some low level of indolent infection in the discs. i can buy the theory that propionum acnes can grow in the relative anaerobic environment of the disc, where there is very poor vasculature.

but, id like to see samples of "normal" discs grow this stuff. id like to see discs + modic changes without pain grow this stuff.

i dont see how you can draw a causal relationship between the presence of these bacteria and back pain. im sure you can have modic changes without the indolent infection.

MAYBE it plays a small role.

however, how many of us have taken weeks worth of antibiotics? does our back pain get better? also, in these ugly looking discs, how long have we done discography? we always inject antibiotics. why have there been no real reports of "therapeutic" discography.

there are too many variables here to to draw a straight line.

in the end, i think we will see that a month of antibiotics in these cases may do a touch of good, but would have just as many negative side effects

 

[NOSfan]

well, you just put me 30 minutes behind today. thanks.

the articles are interesting.

there may be some low level of indolent infection in the discs......

Sorry to put you behind and appreciate your input!

No doubt to date there is no clear etiology or management approach to these patient. Hopefully, as data crystallizes, we will have a better understanding of etiology and treatment options for patients.

Now that I'm behind, going to go get a latte and then get back to work 🙂

 

[emd123]

What I don't understand, is if these modic I changes (which are common) were chronic infection, and for years we have been routinely ignoring them, wouldn't we be seeing a large number of spinal osteomyelitis/discitis cases popping up, from what the authors are saying is a bad enough untreated 'infection' to need many weeks of antibiotics?

That's what doesn't add up to me.

In other words, what happened to all those past ingnored Modic I patients that were left untreated with supposedly smoldering bacterial vertebral body infections? Are they still plugging along with smoldering bacterial infections that are simply causing pain but not causing osteomyelitis or sepsis?

Deep tissues such as bone, disc and the spine don't often get bacterial infections, but when they do, they're very, very nasty. I don't make sense to me, that we've been missing deep seated bacterial bone infections, that aren't leading to anything bad, in the long run. When serious bacterial infections are missed, early, they eventually present themselves as obvious, serious and impossible to ignore infections later. Where are they?

 

[epidural man]

well, you just put me 30 minutes behind today. thanks.

the articles are interesting.

there may be some low level of indolent infection in the discs. i can buy the theory that propionum acnes can grow in the relative anaerobic environment of the disc, where there is very poor vasculature.

but, id like to see samples of "normal" discs grow this stuff. id like to see discs + modic changes without pain grow this stuff.

i dont see how you can draw a causal relationship between the presence of these bacteria and back pain. im sure you can have modic changes without the indolent infection.

MAYBE it plays a small role.

however, how many of us have taken weeks worth of antibiotics? does our back pain get better? also, in these ugly looking discs, how long have we done discography? we always inject antibiotics. why have there been no real reports of "therapeutic" discography.

there are too many variables here to to draw a straight line.

in the end, i think we will see that a month of antibiotics in these cases may do a touch of good, but would have just as many negative side effects

15 min per paper?

Impressive...

 

[SSdoc33]

15 min per paper?

Impressive...

it was a light day.

and i scanned the articles.