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Updated: Oct 18, 2025
In Vivo Mouse Model of Spinal Implant Infection
Published on: June 23, 2020
Study protocol: effect of infection, Modic and inflammation on clinical outcomes in surgery for radiculopathy
Niek Djuric1, Geraldine Lafeber2, Sjoerd G van Duinen3
1Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2300, RC, Leiden, The Netherlands. n.djuric@lumc.nl.
Background:
Evidence indicates that inflammatory processes are involved in radicular pain as well as in resorption of herniated disc tissue. Furthermore there are indications that the presence of vertebral end plate pathology (Modic changes; MC) is associated with a negative effect on inflammation. It is hypothesized that in patients with MC, the (possibly bacterial induced) inflammation will be accompanied by pro inflammatory cytokines that worsen the outcome, and that in patients without MC, the inflammation is accompanied by cytokines that induce a resorption process to accelerate recovery.
Methods:
This prospective cohort study will include 160 lumbar and 160 cervical patients (total of 320), which are scheduled for surgery for either a lumbar or cervical herniated disc with ages between 18 and 75. The main and interaction effects of local bacterial infection (culture), inflammatory cells in disc material (immunohistology), MC (MRI), and blood biomarkers indicating inflammation or infection (blood sample evaluation) will be evaluated. Clinical parameters to be evaluated are leg pain on the 11 point NRS pain scale, Oswestry (lumbar spine) or Neck (cervical spine) Disability Index, Global Perceived Recovery, Womac Questionnaire, and medication status, at baseline, and after 6, 16, 26 and 52 weeks.
Discussion:
Gaining insight in the aetiology of pain and discomfort in radiculopathy caused by a herniated disc could lead to more effective management of patients. If the type of inflammatory cells shows to be of major influence on the rate of recovery, new immunomodulating treatment strategies can be developed to decrease the duration and intensity of symptoms. Moreover, identifying a beneficial inflammatory response in the disc through a biomarker in blood could lead to early identification of patients whose herniations will resorb spontaneously versus those that require surgery.
Trial Registration:
prospectively enrolled at trialregister.nl, ID: NL8464 .
Insights
This study investigates how inflammation and Modic changes (MC) in herniated discs affect radicular pain recovery. Understanding these factors may lead to new treatments for faster symptom relief.
Area of Science:
- Spinal surgery
- Inflammation research
- Biomarker discovery
Background:
- Inflammatory processes are implicated in radicular pain and herniated disc resorption.
- Vertebral end plate pathology (Modic changes; MC) may negatively impact inflammation.
- Hypothesis: MC presence alters cytokine profiles, affecting inflammation and recovery outcomes.
Purpose of the Study:
- To investigate the role of inflammation and Modic changes in herniated disc pain and recovery.
- To differentiate inflammatory responses associated with MC versus no MC.
- To identify potential biomarkers for predicting spontaneous disc resorption.
Main Methods:
- Prospective cohort study of 320 patients undergoing surgery for lumbar or cervical herniated discs.
- Evaluation of local bacterial infection, inflammatory cells, Modic changes (MRI), and blood biomarkers.
- Assessment of clinical outcomes including pain, disability, and recovery over 52 weeks.
Main Results:
- Analysis of inflammatory cells and biomarkers in relation to Modic changes and clinical outcomes is ongoing.
- Correlation between specific inflammatory profiles and the rate/type of disc resorption will be determined.
- Clinical data collection includes pain scores, disability indices, and medication use.
Conclusions:
- Insights into the etiology of radicular pain can improve patient management.
- Identifying influential inflammatory cells may lead to novel immunomodulating treatments.
- Biomarkers could predict spontaneous disc resorption, guiding treatment decisions.
