{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T04:43:23Z","timestamp":1779165803757,"version":"3.51.4"},"reference-count":64,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,9,19]],"date-time":"2023-09-19T00:00:00Z","timestamp":1695081600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2023,9,19]],"date-time":"2023-09-19T00:00:00Z","timestamp":1695081600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000069","name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases","doi-asserted-by":"publisher","award":["R21AR079679"],"award-info":[{"award-number":["R21AR079679"]}],"id":[{"id":"10.13039\/100000069","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["JOR Spine"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This systematic review and meta\u2010analysis aimed to summarize evidence regarding the effectiveness and safety of oral antibiotic intervention for chronic low back pain (CLBP) patients with\/without type\u20101 Modic changes (MC1).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>AMED, CINAHL, Cochrane Library, Embase, and Medline were searched from inception to March 3, 2023. Randomized controlled trials (RCTs) or non\u2010RCTs that investigated the effectiveness or safety of oral antibiotics in treating CLBP patients were eligible for inclusion. Two independent reviewers screened abstracts, full\u2010text articles, and extracted data. The methodological quality of each included article were evaluated by RoB2 and NIH quality assessment tools. The quality of evidence was appraised by GRADE. Meta\u2010analyses were performed, where applicable. A subgroup analysis was conducted to evaluate the RCTs and case series separately, and to evaluate the effect of removing a low\u2010quality RCT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three RCTs and four case series were included. All Amoxicillin\u2010clavulanate\/Amoxicillin treatments lasted for approximately 3 months. Moderate\u2010 and low\u2010quality evidence suggested that antibiotic was significantly better than placebo in improving disability and quality of life in CLBP patients with MC1 at 12\u2010month follow\u2010up, respectively. Low\u2010quality evidence from meta\u2010analyses of RCTs showed that oral antibiotic was significantly better than placebo in improving pain and disability in CLBP patients with MC1 immediately post\u2010treatment. Very low\u2010quality evidence from the case series suggested that oral Amoxicillin\u2010clavulanate significantly improved LBP\/leg pain, and LBP\u2010related disability. Conversely, low\u2010quality evidence found that oral Amoxicillin alone was not significantly better than placebo in improving global perceived health in patients with CLBP at the 12\u2010month follow\u2010up. Additionally, oral antibiotic users had significantly more adverse effects than placebo users.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Although oral antibiotics were statistically superior to placebo in reducing LBP\u2010related disability in patients with CLBP and concomitant MC1, its clinical significance remains uncertain. Future large\u2010scale high\u2010quality RCTs are warranted to validate the effectiveness of antibiotics in individuals with CLBP.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jsp2.1281","type":"journal-article","created":{"date-parts":[[2023,9,19]],"date-time":"2023-09-19T21:48:21Z","timestamp":1695160101000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["The efficacy and safety of oral antibiotic treatment in patients with chronic low back pain and Modic changes: A systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5911-5756","authenticated-orcid":false,"given":"Arnold Y. L.","family":"Wong","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Sciences The Hong Kong Polytechnic University  Hung Hom, Hong Kong SAR China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G. Michael","family":"Mallow","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Rush University Medical Center  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3812-8854","authenticated-orcid":false,"given":"Sabina M.","family":"Pinto","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences The Hong Kong Polytechnic University  Hung Hom, Hong Kong SAR China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7041-3319","authenticated-orcid":false,"given":"Alexander L.","family":"Hornung","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Rush University Medical Center  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel S.","family":"Rudisill","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Rush University Medical Center  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khaled","family":"Aboushaala","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Rush University Medical Center  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter M.","family":"Udby","sequence":"additional","affiliation":[{"name":"Spine Unit Rigshospitalet, University of Copenhagen  Copenhagen Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Howard S.","family":"An","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Rush University Medical Center  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7473-1311","authenticated-orcid":false,"given":"Dino","family":"Samartzis","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Rush University Medical Center  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,9,19]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30480-X"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30489-6"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-147-7-200710020-00007"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000000249"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-016-4459-7"},{"issue":"107","key":"e_1_2_7_7_1","first-page":"108","article-title":"In the spine or in the brain? Recent advances in pain neuroscience applied in the intervention for low back pain","volume":"35","author":"Nijs J","year":"2017","journal-title":"Clin Exp Rheumatol"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-021-06995-x"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.166.1.3336678"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.149.3.531"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0200677"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000003495"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2474-10-81"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000003618"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000000937"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12911-021-01534-6"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2007.10.005"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-022-07125-x"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2015.09.060"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000004301"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/jsp2.1083"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/jor.24195"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/jor.25240"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-015-0267-x"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-017-4972-3"},{"key":"e_1_2_7_26_1","first-page":"875","article-title":"Spondylodiscitis: diagnosis and treatment options","volume":"114","author":"Herren C","year":"2017","journal-title":"Deutsches Arzteblatt Int"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)05109-6"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mehy.2007.05.014"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-013-2675-y"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l5654"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.2144\/fsoa-2021-0026"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f3122"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1177\/0962280219889080"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1186"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d549"},{"key":"e_1_2_7_36_1","volume-title":"Cochrane handbook for systematic reviews of interventions","year":"2019"},{"key":"e_1_2_7_37_1","first-page":"390","article-title":"Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type I changes): a randomized clinical controlled trial of efficacy","volume":"13","author":"Al\u2010Falahi M","year":"2014","journal-title":"Iraqi Postgrad Med J"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00940-017-0534-3"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsm.2008.050369"},{"key":"e_1_2_7_40_1","first-page":"1","article-title":"Antibiotics in the treatment of patients with lower back pain associated with Modic changes: a case series","volume":"3","author":"Gupta G","year":"2017","journal-title":"US Army Med Dep J"},{"key":"e_1_2_7_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbspin.2016.08.001"},{"key":"e_1_2_7_42_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0229228"},{"key":"e_1_2_7_43_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13013-017-0121-3"},{"key":"e_1_2_7_44_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199109000-00001"},{"key":"e_1_2_7_45_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3181573b87"},{"key":"e_1_2_7_46_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2010.137836"},{"key":"e_1_2_7_47_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200212010-00002"},{"key":"e_1_2_7_48_1","doi-asserted-by":"publisher","DOI":"10.1177\/21925682211041618"},{"key":"e_1_2_7_49_1","doi-asserted-by":"publisher","DOI":"10.1097\/AJP.0000000000001008"},{"key":"e_1_2_7_50_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e31822f0a0d"},{"key":"e_1_2_7_51_1","article-title":"Non\u2010steroidal anti\u2010inflammatory drugs for chronic low back pain","volume":"2","author":"Enthoven WT","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_7_52_1","doi-asserted-by":"publisher","DOI":"10.2147\/JPR.S314971"},{"key":"e_1_2_7_53_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000000981"},{"key":"e_1_2_7_54_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2009.108902"},{"key":"e_1_2_7_55_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2005.09.002"},{"key":"e_1_2_7_56_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2013.8992"},{"key":"e_1_2_7_57_1","doi-asserted-by":"publisher","DOI":"10.1002\/ece3.3442"},{"key":"e_1_2_7_58_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2023.03.008"},{"key":"e_1_2_7_59_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000004513"},{"key":"e_1_2_7_60_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-14-13"},{"key":"e_1_2_7_61_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c2096"},{"key":"e_1_2_7_62_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-007-0321-5"},{"key":"e_1_2_7_63_1","doi-asserted-by":"publisher","DOI":"10.1177\/2042098614554919"},{"key":"e_1_2_7_64_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2015.12.037"},{"key":"e_1_2_7_65_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2021.07.012"}],"container-title":["JOR SPINE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jsp2.1281","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jsp2.1281","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jsp2.1281","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T11:11:22Z","timestamp":1771240282000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jsp2.1281"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,19]]},"references-count":64,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024,3]]}},"alternative-id":["10.1002\/jsp2.1281"],"URL":"https:\/\/doi.org\/10.1002\/jsp2.1281","archive":["Portico"],"relation":{},"ISSN":["2572-1143","2572-1143"],"issn-type":[{"value":"2572-1143","type":"print"},{"value":"2572-1143","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,19]]},"assertion":[{"value":"2023-04-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-08-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-09-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e1281"}}