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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  
Exclusions:
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
Exclusions:
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.