Conventional treatment including physiotherapy, chiropractic, acupuncture, and exercise for back pain, are not effective in treating Modic changes.
[11][12] Many individuals suffering from Modic changes, tend to have a high degree of morning stiffness in the back.
In 2008 the first hypothesis suggesting three possible pathogenetic reasons for Modic changes was published, a bacterial, a mechanical, and a rheumatological cause.
[17][18][19][20][21] The mucous membrane of the gums is slightly damaged during ordinary tooth brushing, and anaerobic bacteria Propionibacterium acnes type 2 from the mouth enters the bloodstream.
[22][23][24] The anaerobic bacteria can enter the disc through the breach, causing a low virulent and slowly developing infection.
Therefore, it was hypothesized that diffusion of propionic acid from the disc into the vertebrae results in bone oedema, i.e. Modic changes.
The first study by Stirling and Lambert found Propionibacterium acnes in the extruded disc material in patients undergoing surgery[25] inspired the bacterial theory.
[citation needed] It may be nucleus material entering the vertebrae, but Crock et al. also suggested that after a disc is damaged, irritating substances are produced, draining into the vertebral body, and causing an autoimmune reaction.
[31] This mechanical theory is supported by the fact that histological findings of the Modic Changes demonstrate disruption of the endplates with evidence of chronic inflammation.
This in turn suggests that this erosion weakens the bone matrix, giving rise to stress fractures and consequent oedema.
The proof of an ongoing pathologic process in a Modic change has been documented by SPECT analysis [Isotope scanning using single positron emission computerized tomography], combined with high-resolution CT imaging.
[51] The most commonly recommended treatment for long-lasting pain in the lower back are exercises and fitness training usually under the supervision of a qualified clinician.
A research group led by Gilligan has presented a description of how they hypothesize 4 stages, from infection of the discus to developing Modic changes in the vertebrae.
Since then, in total, 10 studies have been conducted evaluating the effect of antibiotic treatment in patients with chronic low back pain and Modic changes.