Treatment of Degenerative Disc Disease associated with Modic changes, with ozone therapy. A new therapeutic proposal.

Abstract

Introduction. Modic Changes (MCs) represent signal changes in the vertebral endplate and subchondral bone region visualized on T1 and T2 weighted magnetic resonance images (MRI). Three types of MCs It have been identified (Types 1 to 3). Modic changes are commonly associated with low-back pain (LBP). In the last few years scientific papers have shown that one of the causes of MCs (fundamentally, the MCs type 1) is the infection caused by an anaerobic bacterium of very low virulence: Propionibacterium acnes (P. acnes). This bacterium resides on the human skin, oral cavity, intestinal tract, and external ear canal as normal flora. As a consequence of tooth brushing and endodontic-therapy, could invade the blood stream leading to transient bacteremia. The authors propose a treatment which consists of Amoxicillin-clavulanate (500 mg/125 mg) three times a day, at 8-hour intervals, for 90 days/100 days. Objectives. Ozone therapy could be the gold standard therapy for MC1 because ozone is a powerful anti-microbial, anti-inflammatory and analgesic agent, which regulates oxidative stress, immune system and oxygen metabolism. Materials and Methods Patients with LBP lasting 6 months or more and MC1 confirmed by MRI of lumbar spine L3/L4 or L4/L5 or L5/S1 and who responded with 5 or more points on the VAS scale were treated with three intradiscal sessions of ozone therapy and ten paravertebral sessions. Results. Patients who were treated with ozone therapy according to our treatment proposal showed a substantial improvement on VAS comparing the beginning and the end of the treatment. They show a significant difference in pain, and general condition. However, these results were not reflected on ODI scale, neither on the MRI but we could notice certain improvements.