Please Assist- Has Anyone got Modic Changes in their Spine & tried Dr Hannah's antibiotic protocol (MAST)?

Should DWMRI be routinely recommended for Modic 1 changes?

 

We have to use tools that are available, however, despite the remarkable findings of the study with Modic 1 and Claw Sign, as I stated to mft, this is not 100%. It is too early and we do not have enough information, both experimental and clinical, to recommend routine DWMRI for determining infectious from non-infectious Modic 1 changes.

 

Is the data correct? It looks very good, however, it may raise more questions than answers.

 

Is it possible for Modic 1 with p. acnes infection to coexist with staph? Theoretically, infections would react the same, however, it may be an indication of virulence. Would staph infection progress more rapidly than p. acnes?

 

DWMRI results are time dependent. So, the resulting claw sign is an indication of a process that is slower progressing than a typical infection. This would be the case most likely, however, the study indicated multiple methods to determine infection, only some of them biopsies. Furthermore, I am not getting an indication regarding specific pathogens resulting from biopsy. I have had communications with one of the authors and answers are somewhat nebulous.

 

So, are Modic 1 changes with infections by p. acnes considered spondylodiscitis, discitis, osteomyelitis? Is it possible Modic 1 infected with p. acnes is less virulent than staph, progressing at a slower rate, thus giving a false positive with a claw sign? According to a post by mft, the radiologist agreed that her Modic changes with a claw sign on DWMRI were not infectious.

 

We know that with osteomyelitis, fever and blood profiles are often abnormal. This is typically not the case with Modic 1 changes, even when infectious in nature. So, it is possible that we are looking at an infectious process that progresses at a slower rate than typical osteomyelitis or spondylodiscitis.

 

We just need more information. I would presume this is something Dr. Albert would find of vital interest. For now, it is possible that Modic 1 changes without a claw sign is an indication of a more virulent strain of bacteria. The treatment might be intravenous antibiotics and/or in some cases, surgery. This might indicate that Modic 1 changes with a claw sign are still infectious, however, the infection is of a less virulent nature. With no fever or altered blood profiles, you would have to consider this a possibility and the indication for antibiotics would be more dependent on the nature of presenting symptoms and objective findings matching the profile of those who were successfully treated with the antibiotics in Dr. Albert’s study, unless we can find subjective and objective findings that clearly indicate structural from infectious Modic 1 changes.

 

So, the question of recommendations for further investigation, post-standard MRI, with DWMRI must remain questionable considering the costs, compared with a trial of antibiotics. Definitely less invasive that biopsy. Further investigations need to be done. This poses some foundations for future studies.

 

Probably way too early, nevertheless,  has anyone had a DWMRI with a positive claw sign, then responded to the antibiotics or had a biopsy indicating p. acnes?

 

Hi,

I posted on here a while back, so I thought I'd give you all an update.

I finished my 100 days at the end of August. I'm not sure if it was the placeabo effect, but within a month of starting the course, my back pain was greatly reduced. I was convinced I was cured, then did some exercise like I was 30 again. This hurt big time, and took a while to recover from.

I was then far more sensible, and continued to act like the 42 year old that I am.

I can now say, 4 months later, that the course has worked out for me. I still have a numb feeling, in the exact area where my original pain was. But the sciatica has almost completely gone, and I used to get these spasms where I would have to grab onto anything to take my weight off of my spine. I now no longer get those terrible spasms.

I can give my kids piggy back rides, without the 2 day recovery period. I still won't dare to run, and try to avoid impact, but I can cycle and swim stronger than I could for many years.

For me, the course has not been the mirracle cure I'm sure many of you are hoping for, but it really has given me a new lease of life.

Good luck guys!

Dear all,

I have been following carefully this forum since April 2014 when I found it through Google. Carefully, as it is the only one that I was able to find, while being informative, encouraging and giving me lots of hope . Internet is my only source of information regarding Modic 1 changes, as almost the doctors  greet me with a wall when I mention MAST. I am sure you are familiar with that.

I have Modic 1 on L5-S1 plus a Schmorl’s node on the lower L5 plate, and and on L1-L2.  I do not have to take painkillers yet, but the pain bending forward is enough to have had to stop doing all sports. Physio and swimming of course increase the pain. I cannot stop asking myself who am I become.

There are no MAST doctors near where I live, but I do hope that you can help me with your experience. This goal of this post is to get information which could help me decide if should I undergo the antibiotic treatment or not. I prefer to avoid taking antibiotics for 3 months if futile, on the other hand I polled a few doctors and heard that 3 months of AB do not leave a lasting damage, provided taking probiotics in parallel. With the possible perspective of getting herniated nerves, I lean to the AB side.

From the information I have collected, it looks like the chances of MAST treatment success are 50% (mostly from this forum’s posts, and a Powerpoint presentation in Danish by dr. Manniche). It is as if there are two types of Modic 1, half are indeed from bacteria, and the other half could be from plain mechanical damage. The question is for each one of us with Modic 1 is to which half do I belong. I have found 2 papers about the “claw” sign, and I have asked the MRI technician if he would read them and perform the Diffusion Weighted MRI on me.  His verdict was that I have a claw sign, which thus puts me in the plain damage group. However, hope dies the last, and I ask myself if this technician is capable to read it correctly from the first try and after a theoretical text. Is there some other way to figure this out, e.g. from blood analysis and which parameters?  Does somebody of you has a full list? I found out so far that these can indicate an infection (albeit the hypothesis is that Modic 1 does not really create a change of them): CRP, PLT, MPV, SE, KKS, fibrinogen. If I start taking ABs, I will report to the forum how I responded, having a claw sign (this is a sort of answer to mastdoc if somebody has taken ABs with claw sign or not)

What is important about probiotics that I should take? I am not a UK resident, and I may not be able to find the same trade names as in UK.

What is a cold laser therapy? Which frequencies? One producer mentions that 808 nm is best for bone penetration, is it?  Does artificial tanning help to kill the bacteria in the spine? (I read the comment that sun exposure helps.)

Do you have information/experience about recurrence, after the MAST treatment?  E.g. cancer is regarded cured if it does not occur again in 5 years, during which there are regular controls. If bacteria is indeed a cause of 50% of Modic 1 occurrences, and since it is entrenched deep, do antibiotics kill all of them during 100 days, or some manage to survive and strike back after 2-5-10 years?  Did anybody of you have MRI scans before and after the treatment compared, with what results? BTW, it would be great to see a follow-up by dr Albert of her large study.

I am periodically checking about the new studies about zoledronic acid and Pamidronate.  One orthopedic surgeon, skeptic about MAST, asked me how it happens that spinal fusion helps – if it was bacteria, they would keep multiplying inside the bone. The recent post by mastdoc was a good overview about these issues.

I did find a positive comment on Medscape from dr Paul Auwaerter, Clinical Director, Division of Infectious Diseasess (http://www.medscape.com/viewarticle/820717). However, studies involving Modic 1 changes hardly ever mention dr. Albert’s work of 2013, including the one with DW MRI.  There is this strange silence on the net regarding publication of Dr. Albert since the initial wave of publicity in 2013 - there are almost no follow-up studies or comments in the medical literature. I am also curious why is the MAST website not working? Dr. Albert operates now a private practice, and sometimes appears as invited speaker at conferences, however she is not affiliated with any hospital any more. Does anybody knows what is happening behind the scene?

FYI, the NeckSolutions site has to my knowledge the best overview of scientific literature about Modic changes.

Also FYI, I found a Danish Facebook page, here is the link if somebody’s interested, I read it with the help of Google Translate. I found there a link to an interview with their famous TV journalist, who got much better after MAST.

Rosary1, thank you very much for opening this thread, it is so valuable.

Excuse for the long post and thank you very much for your help

Victor

Emis Moderator comment: I have removed a couple of links as they were not working or not suitable for inclusion. If users want these other links please use the Private Message service to request the details.

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Hello everybody,

   I am curious to know why there haven't been any new postings on this forum for some time.

   Is it because Dr. Albert's antibiotic treatment has not been getting good results, in general ?

   Any ideas would be appreciated.

   Thanks,

   William

Hi, I have had lower back pain for about 30 years following a road accident. My treatment was by a chiropractor up until December 2013. From then on the chiropractic treatment failed to work. I assumed it was because my guy had retired and a new guy took over, so I kept going once per month for 6 months. In June 2014 I went to a back specialist consultant neurosurgeon recommended by my GP. following 2 MRIs he diagnosed me with Modic Type 1 condition. he suggested that I might be a candidate for antibiotic treatment, but stressed that he had not tried this before, but that I looked a good candidate. On the basis that there was no guarantee that this would work, I agreed to start the trial. However as I was going on holiday and craved some relief he agreed to inject my back and delay the commencement of get antibiotic treatment for some months.

The benefits of the injection wore off and I started the antibiotics in January 2015, for a period of 3 months. The dosage was 3x 600mgs per day. 

Initially I felt that the pain improved, but I believe that this was caused by an element of 'euphoria' on my behalf.

i had no adverse reactions to the antibiotic, and gradually realised that that pain was abating. 

I had an MRI October 2015 but did not visit the doctor until April 2016. This was because I was not suffering any back pain and he felt I should not waste my money on a further visit with him. 

At My last visit to him 

Continued here:

at my last visit to him, he told me that I was no longer Modic type 1 , that I was now Modic type 2 and showed me a marked difference in the colouring of my two vertebrae which had changed from a dark colour to a much lighter or whiter colour.

He said I no longer need to visit him and also that I am the only patient of his to try this treatment. 

My back pain had been debilitating, to the point that I thought that this was how it would be for the rest of my life. 

Now, my back is stiff, not sore, in the morning when I get out of bed, but quickly improves and I am happy to say that I no longer have any back pain, I have no doubt that this is because of the antibiotic treatment. 

My advice is, if you are diagnosed with Modic type 1 back pain, try the antibiotic treatment, it has worked for me, and my life has improved dramatically,

best wishes, I hope this helps to encourage some people.

Neil. Sounds promising. Yes short story is I have been diagnosed with Modic 1. (Which until I found out about it, I thought it was an adjective...) and have uneviable option of 2 operations.. neithetr I want..and neither the current pain.. Its morning where I am.. and I am just starting work.. (and that has become difficult...) So, Ill try and knuckle down..

I was concerned that there were few personal experiences on the web.. and this thread seemed to have dried up.. But be great to blow some life in it.

I'll return with a fuller back ground story over the enxt day..

Ciao Robert

I completed the 100 days single dose Amoxiclav course in April 2014 under the direction of Alistair Srtirling at the Royal Orthopaedic Hospital, Birmingham who works alongside Hanne Albert on  Modic 1 changes.

I had fractured my spine several times and had multiple bulging and thinning discs. All blood tests taken had been normal. MRI revealed Modic 1 changes but at that time was not sophisticated enough to determine if there was infection or not. I managed the antibiotic course without side effects taking Acidophilus and Saccharomyces Boulardii to remedy the gut 'biome'.

I would say that 7 weeks into the treatment my previously severe back pain had much improved. But an irritable disc may settle itself in this timeline so whether it was the antibiotics or just the disc pain settling with time  I am not sure. Two years on I have recently had a return of the severe pain and had a further MRI. Unfortunately it has shown Modic 1 changes at the same levels as previously but on this occasion it has been reported as having no infective signs. There has been no transition to Type 2 or 3.... I have seen my consultant who has mentioned an L5/S1 spinal fusion in the past but says that current NICE guidelines suggest they are bound to exhaust all conservative interventions first. So has suggested injections. Mastdoc has mentioned intradiscal injections rather than epidural. I cannot tolerate Opiod painkillers or Ibuprofen so am very limited as to painkilling. I have to say I feel my spine is very unstable and feel that fusion is staring me in the face. Ana replied some time ago to say that the state of the bones with Modic 1 changes is very poor which lessens the likelihood of a fusion being successful. I have one of the best spinal surgeons in the world on my side but this  is quite a dilemma.....

I would say to anyone diagnosed with Modic changes by all means try the antibiotics. Unfortunately for myself it has not provided a permanent cure.....

Dear Robert,

I happen to be a consultant physiotherapist in private practice,  specialising in neck and back problems so have 28 years of experience. In all honesty when you have bone on bone between vertebrae it is in my experience better to fuse it or look at an artifical disc replacement which is much more successful in the neck region compared with the lower back.. With fusion there is a degree of 'stiffness' so that neighbouring vertebral levels must compensate. In the neck my experience tells me that there is less 'knock on' effect in de-stabilising  neighbouring vertebral levels compared with the lumbar spine... RFA is one way of controlling the pain but it will not 'cure' you. with fusion you will be pain free.

The only way that physiotherapy would be effective in freeing the pressure on the exiting nerve root is if you had traction. But in the presence of Modic changes which softens the bone this would be potentially dangerous as the bones are vulnerable to microfracture. I know that your answer is a surgical one, keep talking to your team.  If you do have proprionibacterium acnes infection then a course of antibiotics would put the bones in better condition. So I would ask if your MRI showed the presence of infection. 

Good luck in coming to the right decision for you.....