97,469 research outputs found
New perception of childhood as a result of changing gender roles
No full textGender roles are a result and reflection of social change. Owing to gender equality, women are rising to prominence in the area of work, which is one of the significant factors influencing the formation of gender roles. We can observe men slowly entering the private sphere where they are involved in activities limited to taking care of their children. Nevertheless, the asymmetry between the genders persists in both public and private life; the situation has not changed dramatically. However, the emancipation has enabled women to achieve an important position in the society and they are obviously reluctant to lose it. Their awareness of the issue is outrunning the current situation in the society. Striving for success in the labour market, women are now less active at home than they were in the past. Reproduction is no longer a priority in women’s life; instead, they plan their family carefully. As a result of active participation of women in the public area of work, indirect change in family life gave rise to new types of parenthood (new motherhood, new parenthood) and a different attitude towards childhood (protective childhood). Moreover, the resulting new requirements of parenthood are increasingly demanding and exert influence on educational institutions, especially kindergartens. Parents tend to demand more from kindergarten teachers, while children are also changing. The consequences are visible in educational styles, the expectations of parents and their powerlessness
Tsoledronihappohoito Modic-muutoksiin liittyvässä alaselkäkivussa : Vaikutus alaselkäkipuun, magneettikuvauslöydöksiin ja seerumin biomarkkereihin satunnaistetussa lumelääkekontrolloidussa tutkimuksessa
No full textAbstractLow back pain (LBP) is a common symptom among people of all ages and its economic costs are comparable to the costs of cardiovascular diseases, cancer and mental health. Modic changes (MC) are vertebral endplate (EP) and bone marrow changes associated with intervertebral disc degeneration, which are visualized on magnetic resonance imaging (MRI). MC are associated with LBP, type 1 MC (M1) more strongly than other MC types. Effective treatments for LBP related to MC are lacking. Bisphosphonates such as intravenously administered zoledronic acid (ZA), may be a potential treatment option because of its beneficial effect on bone marrow lesions and on pain symptoms in osteoarthritis.This randomized controlled study evaluated the efficacy of a single intravenous infusion of 5 mg of ZA (n=20) in comparison to a saline infusion (n=20) for LBP associated with MC. The effect was evaluated on the basis of LBP intensity and disability, the type and size of MC lesions and serum biomarkers, especially inflammatory and bone turnover markers. ZA reduced LBP intensity in the short term at one month and reduced the use of NSAIDs at one year. ZA tended to speed up the conversion of M1-dominant to type 2-dominant MC and decreased the size of M1-dominant MC, although statistical significance was not reached. Different trends were observed in the serum biomarkers of the ZA and placebo groups. At one year, the concentration of the chemokine IP-10 was elevated in the ZA group and reduced in the placebo group, whereas two bone metabolism biomarkers (AFOS and iPINP) had decreased in the ZA group.In conclusion, ZA is a promising treatment for MC-associated LBP. However, future studies with larger sample size are required.Original papersOriginal papers are not included in the electronic version of the dissertation.Koivisto, K., Kyllönen, E., Haapea, M., Niinimäki, J., Sundqvist, K., Pehkonen, T., Seitsalo, S., Tervonen, O., & Karppinen, J. (2014). Efficacy of zoledronic acid for chronic low back pain associated with Modic changes in magnetic resonance imaging. BMC Musculoskeletal Disorders, 15(1). https://doi.org/10.1186/1471-2474-15-64Self-archived versionKoivisto, K., Järvinen, J., Karppinen, J., Haapea, M., Paananen, M., Kyllönen, E., Tervonen, O., & Niinimäki, J. (2017). The effect of zoledronic acid on type and volume of Modic changes among patients with low back pain. BMC Musculoskeletal Disorders, 18(1). https://doi.org/10.1186/s12891-017-1632-zSelf-archived versionKoivisto, K., Karppinen, J., Haapea, M., Järvinen, J., Kyllönen, E., Tervonen, O., Niinimäki, J., Alini, M., Lotz, J., Dudli, S., Samartzis, D., Risteli, J., Majuri, M.-L., Alenius, H., & Grad, S. (2019). The Effect of Zoledronic Acid on Serum Biomarkers among Patients with Chronic Low Back Pain and Modic Changes in Lumbar Magnetic Resonance Imaging. Diagnostics, 9(4), 212. https://doi.org/10.3390/diagnostics9040212Self-archived versionTiivistelmäAlaselkäkipu on yleinen oire kaiken ikäisillä ihmisillä ja sen taloudelliset vaikutukset ovat verrattavissa sydän- ja verisuonisairauksien, syövän ja mielenterveysongelmien aiheuttamiin kuluihin. Modic-muutokset ovat välilevyrappeumaan liittyviä nikaman päätelevyjen ja rustonalaisen luun muutoksia, jotka voidaan havaita magneettikuvantamisella. Modic-muutokset, etenkin Modic tyyppi 1-muutokset, ovat yhteydessä alaselkäkipuun. Modic-muutoksiin liittyvään alaselkäkipuun ei ole tehokkaita hoitomenetelmiä tarjolla. Bisfosfonaatit, kuten laskimonsisäisesti annosteltava bisfosfonaatti tsoledronihappo, voivat olla potentiaalinen lääke Modic-muutoksiin liittyvään alaselkäkipuun, koska niiden on todettu pienentävän luuytimen muutosten kokoa ja lievittävän oireita polven nivelrikkopotilailla.Tässä satunnaistetussa kaksoissokkotutkimuksessa verrattiin yksittäistä 5 mg tsoledronihappoinfuusiota (n=20) keittosuolainfuusioon (n=20) Modic-muutoksiin liittyvässä alaselkäkivussa. Hoitojen vaikutusta arvioitiin alaselkäkipuun ja alaselkäkivusta aiheutuvaan haittaan, Modic-muutoksen tyyppiin ja kokoon sekä seerumin biomarkkereihin, etenkin inflammaation ja luun aineenvaihdunnan markkereihin. Tsoledronihappo vähensi alaselkäkipua kuukauden kohdalla infuusion jälkeen ja vähensi tulehduskipulääkkeiden käyttöä vuoden seurannassa. Tsoledronihapolla oli taipumus nopeuttaa tyyppi 1-dominanttien muutosten muuntumista tyyppi 2-dominanteiksi ja pienentää tyyppi 1- muutosten kokoa, vaikka tämä ei saavuttanutkaan tilastollista merkittävyyttä. Vuoden kohdalla kemokiini IP-10:n pitoisuus oli noussut merkittävästi tsoledronihapporyhmässä ja pienentynyt lumeryhmässä kun taas kahden luun aineenvaihdunnan markkerin (AFOS ja iPINP) pitoisuudet olivat laskeneet tsoledronihapporyhmässä.Tsoledronihappo on lupaava lääkehoito Modic-muutoksiin liittyvässä selkäkivussa. Tarvitaan kuitenkin lisää tutkimuksia suuremmilla aineistoilla.OsajulkaisutOsajulkaisut eivät sisälly väitöskirjan elektroniseen versioon.Koivisto, K., Kyllönen, E., Haapea, M., Niinimäki, J., Sundqvist, K., Pehkonen, T., Seitsalo, S., Tervonen, O., & Karppinen, J. (2014). Efficacy of zoledronic acid for chronic low back pain associated with Modic changes in magnetic resonance imaging. BMC Musculoskeletal Disorders, 15(1). https://doi.org/10.1186/1471-2474-15-64Rinnakkaistallennettu versioKoivisto, K., Järvinen, J., Karppinen, J., Haapea, M., Paananen, M., Kyllönen, E., Tervonen, O., & Niinimäki, J. (2017). The effect of zoledronic acid on type and volume of Modic changes among patients with low back pain. BMC Musculoskeletal Disorders, 18(1). https://doi.org/10.1186/s12891-017-1632-zRinnakkaistallennettu versioKoivisto, K., Karppinen, J., Haapea, M., Järvinen, J., Kyllönen, E., Tervonen, O., Niinimäki, J., Alini, M., Lotz, J., Dudli, S., Samartzis, D., Risteli, J., Majuri, M.-L., Alenius, H., & Grad, S. (2019). The Effect of Zoledronic Acid on Serum Biomarkers among Patients with Chronic Low Back Pain and Modic Changes in Lumbar Magnetic Resonance Imaging. Diagnostics, 9(4), 212. https://doi.org/10.3390/diagnostics9040212Rinnakkaistallennettu versioAcademic dissertation to be presented with the assent of the Doctoral Training Committee of Health and Biosciences of the University of Oulu for public defence in Auditorium A101 (Aapistie 7 A), on 20 August 2021, at 12 noonAbstract
Low back pain (LBP) is a common symptom among people of all ages and its economic costs are comparable to the costs of cardiovascular diseases, cancer and mental health. Modic changes (MC) are vertebral endplate (EP) and bone marrow changes associated with intervertebral disc degeneration, which are visualized on magnetic resonance imaging (MRI). MC are associated with LBP, type 1 MC (M1) more strongly than other MC types. Effective treatments for LBP related to MC are lacking. Bisphosphonates such as intravenously administered zoledronic acid (ZA), may be a potential treatment option because of its beneficial effect on bone marrow lesions and on pain symptoms in osteoarthritis.
This randomized controlled study evaluated the efficacy of a single intravenous infusion of 5 mg of ZA (n=20) in comparison to a saline infusion (n=20) for LBP associated with MC. The effect was evaluated on the basis of LBP intensity and disability, the type and size of MC lesions and serum biomarkers, especially inflammatory and bone turnover markers. ZA reduced LBP intensity in the short term at one month and reduced the use of NSAIDs at one year. ZA tended to speed up the conversion of M1-dominant to type 2-dominant MC and decreased the size of M1-dominant MC, although statistical significance was not reached. Different trends were observed in the serum biomarkers of the ZA and placebo groups. At one year, the concentration of the chemokine IP-10 was elevated in the ZA group and reduced in the placebo group, whereas two bone metabolism biomarkers (AFOS and iPINP) had decreased in the ZA group.
In conclusion, ZA is a promising treatment for MC-associated LBP. However, future studies with larger sample size are required.Tiivistelmä
Alaselkäkipu on yleinen oire kaiken ikäisillä ihmisillä ja sen taloudelliset vaikutukset ovat verrattavissa sydän- ja verisuonisairauksien, syövän ja mielenterveysongelmien aiheuttamiin kuluihin. Modic-muutokset ovat välilevyrappeumaan liittyviä nikaman päätelevyjen ja rustonalaisen luun muutoksia, jotka voidaan havaita magneettikuvantamisella. Modic-muutokset, etenkin Modic tyyppi 1-muutokset, ovat yhteydessä alaselkäkipuun. Modic-muutoksiin liittyvään alaselkäkipuun ei ole tehokkaita hoitomenetelmiä tarjolla. Bisfosfonaatit, kuten laskimonsisäisesti annosteltava bisfosfonaatti tsoledronihappo, voivat olla potentiaalinen lääke Modic-muutoksiin liittyvään alaselkäkipuun, koska niiden on todettu pienentävän luuytimen muutosten kokoa ja lievittävän oireita polven nivelrikkopotilailla.
Tässä satunnaistetussa kaksoissokkotutkimuksessa verrattiin yksittäistä 5 mg tsoledronihappoinfuusiota (n=20) keittosuolainfuusioon (n=20) Modic-muutoksiin liittyvässä alaselkäkivussa. Hoitojen vaikutusta arvioitiin alaselkäkipuun ja alaselkäkivusta aiheutuvaan haittaan, Modic-muutoksen tyyppiin ja kokoon sekä seerumin biomarkkereihin, etenkin inflammaation ja luun aineenvaihdunnan markkereihin. Tsoledronihappo vähensi alaselkäkipua kuukauden kohdalla infuusion jälkeen ja vähensi tulehduskipulääkkeiden käyttöä vuoden seurannassa. Tsoledronihapolla oli taipumus nopeuttaa tyyppi 1-dominanttien muutosten muuntumista tyyppi 2-dominanteiksi ja pienentää tyyppi 1- muutosten kokoa, vaikka tämä ei saavuttanutkaan tilastollista merkittävyyttä. Vuoden kohdalla kemokiini IP-10:n pitoisuus oli noussut merkittävästi tsoledronihapporyhmässä ja pienentynyt lumeryhmässä kun taas kahden luun aineenvaihdunnan markkerin (AFOS ja iPINP) pitoisuudet olivat laskeneet tsoledronihapporyhmässä.
Tsoledronihappo on lupaava lääkehoito Modic-muutoksiin liittyvässä selkäkivussa. Tarvitaan kuitenkin lisää tutkimuksia suuremmilla aineistoilla
Joshua Davis: Author of Spare Parts
No full textCitation: K-State First (2016). Joshua Davis: Author of Spare Parts [Flier]. Manhattan, Kansas: K-State First.Flyer advertising Joshua Davis's author talk at Kansas State University
Steven Johnson Author Talk Poster
No full textK-State Book NetworkA poster advertising an author talk by Steven Johnson at Kansas State University on September 3, 2014. Steven Johnson's book "The Ghost Map" was the 2014-2015 common book
Effects of Eschericia coli physiology on latent period and burst size of bacteriophage T4
No full textBakteriofagi so virusi, ki se brez bakterij ne morejo razmnoževati. Ravno zaradi te lastnosti so v zadnjem času, ko se število odpornih bakterij na antibiotike zvišuje, ponovno postali zanimivi, saj jih lahko uporabljamo kot zdravilo za zdravljenje bakterijskih infekcij. Študije interakcij med bakterijami in fagi so zato ključnega pomena. Pri eksperimentalnem delu smo v prvem delu s šaržnim gojenjem okarakterizirali rast bakterije Escherichia coli K-12 v kompleksnem gojišču LB. V nadaljevanju smo bakterijsko kulturo gojili v kemostatu, kjer smo lahko natančno uravnavali hitrost rasti in s tem fiziološko stanje bakterije. Pri šestih različnih hitrostih redčenja (0,24-0,98h-1) smo določili razmerje med celokupno RNA in celokupnimi proteini. Rezultati so pokazali, da se razmerje linearno povečuje s povečevanjem hitrosti redčenja. Želeli smo tudi določiti morebitne razlike v velikosti bakterijskih celic med različnimi hitrostmi redčenja, vendar je bila ločljivost svetlobnega mikroskopa premajhna. V drugem delu pa smo določili vpliv fiziološkega stanja bakterijske kulture na rastne parametre faga T4. Bakterije smo pobili s kloroformom, koncentracijo fagov pa smo določili z metodo štetja plakov. Prvi rastni parameter faga, ki smo ga določali, je bila adsorbcijska konstanta. Rezultati so pokazali, da se adsorbcijska konstanta z višanjem hitrosti redčenja zmanjšuje. Latentno periodo in pomnožitveno število fagov smo določili pri poskusu enostopenjske rasti. Latentna perioda se je od najmanjše do najvišje hitrosti redčenja skrajšala za skoraj polovico (od 43 min do 25 min). Po drugi strani pa se je pomnožitveno število fagov pri enakih pogojih zvišalo iz 21 PFU/bakterijo na 57 PFU/bakterijo, kar je skoraj trikrat več kot pri najnižji hitrosti rasti.Bacteriophages are viruses that can\u27t reproduce without the presence of bacteria. In light of the recent increase in antibiotic resistant bacteria they\u27re resurfacing in contemporary research due to their potential as an effective alternative to antibiotic treatments. To achieve this goal it is crucial to research the interactions between bacteria and phages. In the first stage of experimental work we characterised the growth of bacteria Escherichia coli K-12 in complex LB medium as a batch culture. In the next stage we cultivated the bacteria in chemostat, where we were able to precisely regulate growth rate and therefore the physiology of the bacteria. RNA/protein ratio was determined at six different dilution rates (0,24-0,98h-1). From the results it is evident that the ratio is linearly increasing with the increase of dilution rate. We also wanted to determine changes in cell size at different dilution rates but due to the low resolution of the light microscope we were unable to do so. In the second stage we determined if the growth parametres of phage T4 are effected by changes in bacterial physiology. Phage titer was determined by plaque assay method. The first phage growth parameter that we determined was the phage adsorption. Results show that with increasing dilution rate the adsorption constant is decreasing. Latent period and burst size was determined with the one-step growth experiment. Latent period dropped by almost half from the lowest to the highest dilution rate from 43 min to 25 min. On the other hand the burst size increased almost threefold from the lowest to the highest dilution rate from 21 PFU/bacterium to 57 PFU/bacterium
The heritability and morphology of lumbar Modic changes and their association with pain
No full textAbstract
Low back pain (LBP) causes enormous costs to society. Certain magnetic resonance imaging (MRI) findings, including disc degeneration and disc herniation, have been associated with LBP in epidemiologic studies. Even though LBP should be considered a biopsychosocial condition, there is a need to define the possible existence of specific pathological conditions beyond LBP. One of these possible conditions is Modic change (MC). Modic changes are subchondral and vertebral bone marrow changes revealed by MRI. Although their association with LBP has been previously studied, some results remain contradictory, and we need to explore MC more thoroughly and to determine whether they are a feature of intervertebral disc degeneration or whether they exist in isolation. Moreover, it is unknown whether heritability is a contributing factor to MC.
This study explored the heritability and morphology of MC and their association with severe, prolonged and disabling LBP. The data consisted of two general population samples, TwinsUK from the United Kingdom (mainly female), and the Hong Kong Disc Degeneration Cohort (HKDDC) from Hong Kong, China. The TwinsUK sample included a longitudinal ten-year follow-up, whereas the HKDDC sample was cross-sectional.
The heritability of MC was found to be 30%. Modic changes were associated with other MRI findings such as disc degeneration, disc displacement and Schmorl’s nodes. A greater size of MC increased these associations. Type 1 MC were more strongly associated with disc displacement and disc degeneration than Modic type 2 change. Modic changes appeared to be independently associated with disabling LBP; severe, prolonged LBP; and back-related disability. Posterior MC and MC in the whole antero-posterior (AP) length of the vertebral body were more strongly associated with severe, prolonged LBP than other MC. A greater number and size of MC increased this association. In terms of disc degeneration, MC were independently associated with loss of disc height and disc signal intensity. Incident MC were independently associated with loss of disc height and disc bulge in a ten-year follow-up.
Modic changes are heritable, and are associated with severe and disabling LBP. The location, size and number of MC affect the association of MC with other MRI findings, LBP and back-related disability.Tiivistelmä
Alaselkäkivusta aiheutuu valtavat kustannukset yhteiskunnalle. Tietyt magneettikuvauslöydökset, kuten välilevyrappeuma ja välilevytyrä, on yhdistetty alaselkäkipuun epidemiologisissa tutkimuksissa. Alaselkäkipua arvioidaan yleensä biopsykososiaalisen mallin avulla, koska sen syytekijät tunnetaan huonosti. Lannerangan Modic-muutoksia pidetään yhtenä mahdollisena alaselkäkivun syytekijänä. Modic-muutokset ovat rustonalaisia, nikaman luuytimen muutoksia, jotka näkyvät magneettikuvantamisella. Tulokset Modic-muutosten ja alaselkäkivun yhteydestä ovat kuitenkin ristiriitaisia. Modic-muutosten sijainnin, koon ja muodon vaikutus alaselkäkipuun tunnetaan edelleen puutteellisesti. Lisäksi niiden perinnöllisyys on epäselvä.
Tässä tutkimuksessa tarkasteltiin Modic-muutosten perinnöllisyyttä ja tarkempaa morfologiaa, kuten sijaintia ja kokoa lannerangassa, sekä selvitettiin niiden yhteyttä haittaavaan ja voimakkaaseen alaselkäkipuun. Tutkimus perustui kahteen väestöperäiseen aineistoon: TwinsUK-kaksosaineistoon (pääosin naisia) Yhdistyneistä kuningaskunnista ja Hong Kong Disc Degeneration -kohorttiin Hongkongista, Kiinasta. TwinsUK-aineisto sisälsi seurantatietoja 10 vuoden ajalta, ja Hongkongin aineisto oli kerätty yhdestä aikapisteestä.
Modic-muutosten perinnöllisen osuuden todettiin olevan 30 %. Modic-muutokset olivat yhteydessä muihin magneettikuvauslöydöksiin kuten välilevyrappeumaan, välilevypullistumaan ja Schmorlin keräsiin. Tyypin 1 Modic-muutokset olivat voimakkaammin yhteydessä välilevypullistumiin ja -rappeumaan kuin tyypin 2 muutokset. Modic-muutokset olivat yhteydessä toimintakykyä alentavaan ja voimakkaaseen, pitkittyneeseen alaselkäkipuun. Koko nikaman läpimitan käsittävät ja nikaman takaosassa sijaitsevat muutokset olivat voimakkaammin yhteydessä alaselkäkipuun. Muutosten suurempi koko ja yhteislukumäärä lannerangassa voimistivat sen yhteyttä alaselkäkipuun. Modic-muutokset olivat yhteydessä välilevyn madaltumiseen ja signaali-intensiteetin laskuun. Kymmenen vuoden seuranta-aikana ilmaantuneet Modic-muutokset olivat yhteydessä välilevyn madaltumiseen ja välilevypullistumaan.
Modic-muutokset ovat perinnöllisiä ja ne ovat yhteydessä voimakkaaseen sekä toimintakykyä heikentävään alaselkäkipuun. Muutosten tyypin lisäksi niiden sijainti, koko ja lukumäärä tulee huomioida alaselkäkipua arvioitaessa
Degenerative marrow (modic) changes on cervical spine MRI scans: prevalence, inter- and intra-examiner reliability and link to disc herniation
No full textABSTRACT: Study Design. A prevalence and reliability study of Modic changes in the cervical spine.Objective. To assess the prevalence and reliability of diagnosing and classifying Modic changes and their relationship to disc herniations in the cervical spine.Summary of Background Data. Degenerative marrow (Modic) changes in the spine can be seen on MRI with some evidence linking them to pain. Many studies have been published on Modic changes in the lumbar spine, but only 1 small prevalence study focusing on Modic changes in the cervical spine has been reported.Methods. The cervical MRI scans of 500 patients over the age of 50 were retrospectively evaluated for the prevalence, type and location of Modic changes and disc herniations. 200 of these same scans were independently analyzed by a second observer to evaluate interobserver reliability of diagnosis with 100 re-evaluated by the same observer 1 month later to assess intraobserver reliability. The SPSS program and Kappa statistics were used to assess prevalence and reliability. The risk ratio comparison of DH and MC was calculated.Results. 426 patients (85.2 %) met the inclusion criteria. Modic changes were observed in 40.4% of patients (14.4% of all motion segments). 4.3% were type 1 and 10.1% were type 2. Disc herniations were seen in 78.2% of patients (13.3% of motion segments). Both MC and DH were most frequently observed at C5/6 and C6/7. Disc extrusions were positively associated with MC (RR = 2.4). The reliability demonstrated an upper moderate interobserver (k = 0.54) and an almost perfect intraobserver agreement (k = 0.82).Conclusions. A high prevalence of Modic changes was observed with type 2 predominating. The C5/6 and C6/7 levels are most effected. Patients with MC are more likely to have a disc herniation at the same level. MC type 2 predominates. The classification is reliable
Pattern of Spine Degenerative Disease Among Patients Referred for Lumbar Magnetic Resonance Imaging at Muhimbili National Hospital, Dar es salaam, Tanzania March-September-2010.
No full textAbstract Background Degenerative disease of the lumbar spine refers to a syndrome in which an intervertebral disk with adjacent spine structures are compromised. This causes low back and lower extremity pain. The syndromes encompasses the following degenerative changes:.disk degeneration, Modic changes, disk displacement, nerve root compression, facet joints arthropathy, ligamentum flavum hypertrophy and spine canal stenosis. The modality of choice for imaging this syndrome is Magnetic Resonance Imaging (MRI). Objective: Assessment of pattern of lumbar spine degenerative disease among patients with with/without radiculopathy, referred for lumbar MRI at Muhimbili National Hospital(MNH) from March-September 2010. Methodology: This descriptive cross-sectional study involved 165 individuals selected from patients referred for lumbar MRI at MNH. A questionnaire was administered to obtain patient demographic data and clinical information. In all participants, lumbar MRI scans were performed through L1-S1 intervertebral disc spaces. Six degenerative findings were looked at: (i) disk degeneration (ii) Modic changes (iii)disk bulge (iv) disk herniation (v)central canal stenosis (vi)nerve root compression. Statistical analysis was performed using computer program Statistical Package for Social Sciences (SPSS) version; 13. Chi-square test was, used to compare between age, gender, symptomatology and MRI findings. A p-value of <0.05 was considered to indicate statistically significant difference. Results The mean age of participants was 50±12.5 years. Eighty percent (80%) of participants presented with LBP with radiculopathy. After lumbar MRI, 93.9% of participants had at least one degenerative finding. Disk degeneration was found in 83% of individuals, in at least one intervertebral disc level, Modic changes (28%), disc bulging (39%), disc protrusion (63%), vi central canal stenosis (30%) and nerve root compression (77%) were detected. Type II Modic changes were more common than type I (22% and 6% respectively: p-value: 0.022). Ninty eight percent of herniated disks were protrusions. Two percent of herniated disks were extrusions and the most location for disk herniation was postero-lateral seen in 75% of herniated disks. None of the participants had disk sequestration. The degenerative imaging findings were increasing significantly with age and there was no significant sex difference. All degenerative findings were seen at lower lumbar levels (L4/L5&L5/S1) but were more common at the L4/L5. Disk herniations, central canal stenosis and nerve root compression were common in patients with radiculopathy than in patients with LBP only (p-value 0.000). Conclusion Majority (93.9%) of participants had at least one degenerative imaging finding. The most frequent degenerative finding was disk degeneration(83%). Posterolateral was the most common location for disk herniation. Disk herniation, canal stenosis and nerve root compression were significantly seen in patients with radiculopathy. There were no sequestered disks found in the studied patients. Recommendations 1) MR axial images should be obtained in a contiguous manner 2) Careful evaluation of images is needed as different types of lumbar spine degenerative findings are common among patients referred for Lumbar MRI 3) There is a need of more studies to be conducted on spine degenerative disease using bigger sample size
Chronic low back pain with Modic changes: Antibiotic treatment and clinical characteristics
No full textModic changes are vertebral changes extending from the endplate visible on an MRI, and are associated with back pain. A randomized trial from 2013 concluded that 3 months oral amoxicillin/clavulanate treatment provide a large effect for patients with chronic low back pain and Modic changes. This led to increased antibiotic treatment for low back pain. The scientific environment required that the results should be replicated in further trials before treatment guidelines could be changed for this patient group.
This thesis is based on the AIM-study (Antibiotics in Modic changes) that was initiated to reassess the results of the 2013-trial. At six Norwegian hospitals, a total of 180 patients with chronic low back pain and Modic changes were randomized to 100 days of encapsulated amoxicillin or placebo. All patients, trial staff, researchers and statisticians were blinded to the treatment group.
The results showed that there were no clinically significant differences between the antibiotic group and the placebo group in patient reported outcome measures of disability, pain intensity or quality of life at one year follow-up. Neither were there any clinically relevant differences in subgroups of patients, defined by the type of Modic changes or clinical information.
In addition, it was investigated whether patients with type 1 Modic changes (oedema type) have different clinical outcomes and measurements compared to patients with type 2 Modic changes (fatty type). No relevant differences were found between patients with these types of Modic changes.
The key message from this thesis is that the results of the AIM-study did not support the use of antibiotic treatment for chronic low back pain and Modic Changes
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