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Some patients with chronic low back pain have magnetic resonance imaging (MRI) signal changes in the vertebral bone marrow known as “Modic changes,” which are classified as Modic type 1 (edema), 2 (fatty), or 3 (sclerotic) changes. One hypothesis is that Modic changes are caused by low-grade bacterial discitis following disc herniation, because several studies have shown commensal skin organisms (e.g., Propionibacterium acnes) in spinal disc material. In a previous randomized trial with methodologic flaws, amoxicillin-clavulanate was superior to placebo in patients with chronic low back pain, prior disc herniation, and Modic 1 changes (Eur Spine J 2013; 22:697).
In a new double-blind randomized trial, 180 patients (mean age, 45) with low bac…