Modic changes have recently been receiving a lot of interest from the popular press. This is due to an MRI finding, having clinical importance, which had not previously been seen.  A high percentage of test subjects respond favourably to long term antibiotic treatment. This is significantly better than results of all other conventional treatments. The bacteria involved have also been identified. This is a very large step forward in the diagnosis and treatment of chronic lower back pain. A breakthrough like this has not occurred for many decades.

It is important to establish a solid case history. A consultation always begins with a review of all matters relating to the patient’s back pain.  This enables a clinician to form an index of suspicion pointing towards possible Modic changes.

Things to look out for:

• The subject has had a disc herniation fairly recently.
• Conventional treatments have not seen results.
• Change in their pain, become constant and more severe as opposed to activity related.
• Deep pain within the spinal segments.
• Location of the pain can be accurately pinpointed.
• Night pain.
• Unable to exercise or partake in physical activity.

Orthopaedic and neurological examination is normal but Modic patients are typified by;

• Total inability to bend forward.
• Decrease in movement in every direction.
• Applying pressure to the involved vertebra identifies the pain. This is known as the springing test.

Modic changes require an MRI scan to confirm the diagnosis. Modic changes types 1,2,& 3 can be “interpreted” by an experienced radiologist.  Modic type 1 changes are strongly related to pain while Modic changes type 2 are slightly less correlated to pain. Modic changes type 3 are not correlated to pain at all.

Determining whether a patient’s symptoms are related to Modic changes involves a 3 step process – each with their own characteristic findings.

Our journal contains more information about Modic Changes and Antibiotic Treatment, and how these patients differ.