Written by Sander van Bergen25-12-2013 13:00:00. Posted in Lumbar

Test your knowledge: Modic changes in lumbar vertebrae

Question:

Modic changes are pathological changes in the vertebrae of the spine. A precursor in modic changes of the vertebra is a mechanical lumbar disc herniation. Most of the times, only mechanical causes of the lumbar disc herniation are considered and discussed with patients.   

There are 2 possible pathogenetic mechanisms that can cause a lumbar disc herniation and the resulting modic changes. Do you know the other cause of disc herniation (so, no mechanical cause!)? You’ll be amazed when you read the answer provided in recent literature!

Answer:

An infection of the nuclear tissue is the other cause of disc herniation. In a study by Albert et al. (2013), in 53% of the investigated patients virulent anaerobic microorganisms were present in the lumbar discus (sterile environment during surgery).   

These type of microorganisms are found in hair follicles and the oral cavity. They frequently invade the circulatory system (after tooth brushing for example), but do not have important health risks because of the aerobic environment of the blood stream.   

During disk herniation there are a lot of little blood vessels built around the extruded disc material. Inflammation occurs and there is an increased level of macrophages. The lumbar disc is avascular (not the peripheral part, but >80% of the disc).   

This could be an ideal environment for the anaerobic bacteria, which circulate in the little blood vessels of the extruded disc material. These bacteria give rise to a slowly developing infection. So, is an antibiotic treatment a well-substantiated treatment of (some) lumbar disc herniations? More research is required to underpin the right treatment for the patient with low back disc herniation. Think about it. > From: Albert et al., Eur Spine J 22 (2013) 690-696. All rights reserved to The Author(s). 

Visit the PubMed summary for more information or your article access. Also, see the list of expert responses below the summary; the theory postulated in the article is still subject of debate!