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Table 5 Characteristics of the 11 identified studies

From: Could low grade bacterial infection contribute to low back pain? A systematic review

Studies Study design Demographics, n (% Female) Clinical features and surgery performed Study inclusions/exclusions (includes previous interventions) Modic changes examined Control group Quality score
Mean age (years)
Disc studies      
Albert [2] Cross-sectional/ cohort 61 (27% F) Disc herniation Inclusions: Yes – Type, size, and volume were graded according to the Nordic Modic Protocol No 78/75
Age: 46.4 Primary surgery at a single spinal level 18 to 65 years old
MRI-confirmed lumbar disc herniation  
Received antibiotic treatment within previous 2 weeks
Stirling [14] Cross-sectional 36 (NA) Discogenic radiculitis Not specified No No 78
Age: NA Microdiscectomy
Stirling [17] Cross-sectional 207 (NA) Discogenic radiculitis Not specified No Yes – patients with trauma, tumour, or scoliosis 56
Age: NA Microdisectomy
Agarwal [16] Cross-sectional 52 (42% F) Radiculopathy Inclusions: No No 78
Age: 43.9 Disc herniation Sensory or motor symptoms in a single lumbar nerve distribution
Lumbar microdiscectomy
Positive physical examination findings (positive straight leg raise test, distributional weakness, diminished deep tendon reflexes)
MRI lumbar spine positive for HNP
Diabetes mellitus, oral steroid use in the month before surgery, other immunosuppressive medications
Plain radiography demonstrating severe loss of disc height
High grade degenerative disc disease, spondylolisthesis > grade 1
History of prior lumbar surgery, multilevel symptomatic HNP or trauma
Red flags (progressive weakness, bowel/bladder complaints, radiographic unknown mass, unexpected weight loss)
Diagnosis of inflammatory arthritides, crystalline arthropathies, or other rheumatologic diseases
Arndt [9] Cross-sectional 83 (59% F) Disc degeneration Not specified Yes – Type 1 and 2 according to the Modic classification No 67
Age: 41 Lumbar disc replacement at L3-4, L4-5, or L5-S1
Coscia [11] Cross-sectional 165 (NA) Disc herniation Not specified No Yes – Five groups, including cervical disc herniations, lumbar disc herniations, lumbar discogenic pain, deformity, and control 78
Age: NA Surgery not specified
Ben-Galim [10] Cross-sectional 30 (40% F) Disc herniation Exclusions: No No 67
Age: 46.4 (NA) Lumbar discectomy Individuals who had been treated with antibiotics in the 2 months preceding the study
Those who had undergone back surgery
History of intradiscal injections
Fritzell [12] Cross-sectional 10 (40% F) Disc herniation Not stated No No 67
Age (range): 20–47 Surgery not specified
Carricajo [13] Cross-sectional 54 (41%) Disc herniation Not stated No No 67
Age: 44.8 (NA) Surgery not specified
Albert [1] Randomised controlled trial Intervention group: Chronic LBP (>6 months) occurring after a previous disc herniation and who also had Modic type 1 changes in the vertebrae adjacent to the previous herniation Inclusions: Yes – Modic Type 1 only; size and volume of Modic changes were graded according to the Nordic Modic Protocol Yes 100
Aged between 18 and 65 years
90 (58.2% F) MRI-confirmed disc herniation L3/L4 or L4/L5 or L5/S1 within the preceding 6–24 months
Age: 44.7 (10.3)
Placebo group: Lower back pain of >6 months duration
72 (58.2% F) Nil surgery Modic type 1 changes adjacent to the previously herniated disc on repeat MRI
Age: 45.5 (9.2) Exclusions:
Allergy to antibiotics
Current pregnancy or lactation
Any kidney disease
Pending litigation
Bone studies
Wedderkopp [15] Cross-sectional 24 (58% F) ‘Persistent LBP’ Modic type I changes in at least 1 vertebra Inclusion: Type 1 Modic changes on MRI Yes – Modic Type 1 only No 67
Age: 43 (NA)
No surgery performed
  1. HNP, Herniated nucleus pulposus; LBP, Low back pain.