What is a herniated disc?
A herniated disc is an injury to the structure of the spine, and it is often very painful. The spine consists of vertebrae that are kept together by elastic ligaments and intervening ‘intervertebral discs’. This intervertebral disc is also called ‘discus’ in Latin and consists of connective tissue and a centrally positioned ‘jellylike’ core. The intervertebral discs are shock-absorbent and enable the spine to move, and in the back of the spine, we find the spine canal. Here, the nerve paths from the brain to the periphery pass through. A discus, which is out of place and pressing on this nerve bundle, will irritate the nerves and cause pain. Herniated discs are frequent in traffic accidents, trauma sustained from falling, or a sudden strain of the spine. Moreover, old age is associated with herniated discs as the connective tissue breaks down over time, weakening it and enabling the soft core to move out of place and put pressure on the spinal cord. The symptoms include reduced power or paralysis of one or more muscles as well as sensory disturbances and pain that radiates out into arms or legs.
Are bacteria causing the pain?
More recent research has observed that some herniated discs were infected with bacteria. These bacteria may influence changes that occur in the bones and the tissue following a herniated disc. These changes are called ‘modic changes’. This has caused great interest in antibiotics being part of the treatment of lower back pain. In 2015, researchers conducted a meta-analysis that analysed 11 studies, which had examined the connection between bacteria and herniated discs. The results showed that about 34 % of the study subjects from the different studies had bacteria in the tissue from the herniated disc. The most frequent bacterium was ‘Propionibacterium Acnes’. At the same time, the analysis showed that the bacteria contributed to the so-called ‘modic type 1’ changes, and that the pain was related to the condition. These changes are characterised by bone oedema in the vertebrae.
Can antibiotics treat lower back pain?
Often, a herniated disc is treated with a surgical procedure, but this discovery questioned this treatment. Could antibiotics relieve the back pain? A Danish study from University of Southern Denmark showed that many herniated discs were infected with bacteria, and that antibiotics over a three-month period could treat the symptoms in as much as 75 % of the cases.
A different study also investigated a group of patients with lower back pain caused by a herniated disc over a course of a minimum of 6 months, and the results showed modic type 1 changes. Half were given a placebo, while the other half were given antibiotics for 100 days. Researchers discovered a notable change that was greatest in those treated with antibiotics. Here, the patients had a significantly reduced degree of the following outcomes, which were used to measure the performance of the antibiotic; lower back pain, back pain in general and disease related impairment of overall function. Research is still being done in this field, but current results suggest that lower back pain caused by a herniated disc, may be treated with antibiotics in the future.
