Association between sciatica and Propionibacterium acnes Serological test (exocellular antigen produced by gram-positive bacteria (lipid S)) to diagnose deep-seated infections caused by low virulent gram-positive microorganisms. 43 of 140 (31%)patients with sciatica tested positive. 36 patients with severe sciatica (MR scanning: Discogenic radiculitis) who had undergone microdiscectomy was cultured for the presence of microorganisms. 19 of these patients (53%) had positive cultures after long-term incubation. Propionibacterium acnes was isolated from 16 of the 19 (84%) positive samples. Microorganisms were not detected in any of the 11 gram-stained thin sections examined by direct microscopy, suggesting that they are present only in low numbers. Alistair Stirling, Tony Worthington, Mohammed Rafiq, Peter A Lambert, Tom S J Elliott THE LANCET Vol 357 June 23, 2001

Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized clinical controlled trial of efficacy Hanne B. Albert Joan S. Sorensen Berit Schiott Christensen Claus Manniche Eur Spine J (2013) 22:697–707 DOI /s y H. B. Albert (&) J. S. Sorensen C. Manniche Research Department, Spine Centre of Southern Denmark, Institute of Regional Health Services Research, Lillebaelt Hospital, University of Southern Denmark, Middelfart, Denmark B. S. Christensen Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark

Purpose : Modic type 1 changes/bone edema in the vertebrae are present in 6 % of the general population and 35–40 % of the low back pain population. It is strongly associated with low back pain. The aim was to test the efficacy of antibiotic treatment in patients with chronic low back pain ([6 months) and Modic type 1 changes (bone edema). Modic (MRI) and three types have been identified (Types 1–3). Type 1 involve disruption and fissuring of the endplate with regions of degeneration, regeneration, reactive bone formation, endplate edema and vascular granulation tissue 1 = endplate only, 2 = up to 25 %, 3 = up to 50 % 4 = above 50 % of the vertebrae. Patients also had to have LBP in the area from L1 to L5 with a Numerical Pain Rating Scale score of C6 after adding the current LBP (0–10)

The initial inclusion criteria were: years, MRI-confirmed disc herniation L3/L4 or L4/L5 or L5/S1 (6–24 months), lower back pain of >6 months duration, Both conservative and surgically treated patients were included, regardless of sciatica, neuropathic pain or not. Dobbeltblindet (til 1 års kontrol), 162 pt, 147 (treatment questionnaires), 144 (1-year follow up) Amox-clavulan (500 mg/125 mg), 1x3 tbl. dgl eller 2x3 tbl. I 100 dage