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 | |||||||