Modic Antbiotic Spinal Therapy (MAST). Early experience in the use of antibiotics in Modic-related back pain (MRBP). A case report and prospective, open-label, observational study.

Anthony Hammond




Modic change is common in the back pain population. Recent reports of successful antibiotic therapy in post disc surgical cases of progressive Modic change and back pain raise the possibility of improvement for difficult to treat patients. I here report successful antibiotic treatment in a post disc surgical patient with progressive painful Modic change and the result of the treatment of 33 further cases of mixed aetiologies.


The case of a 35 yr old patent who had undergone successful discectomy for sciatica and who subsequently developed progressive Modic Type 1 change and disabling back pain is presented. The patient showed and excellent response to MAST treatment adapted for penicillin allergy.


Open label, prospective collection of MAST standardised data in daily clinical practice by one practitioner in two settings (independent NHS and Private Practice) of 36 sequential cases.


33 patients are available for evaluation to date.  Of these: 3 were non-compliant and one withdrew consent. Of those who commenced treatment 22.3% failed to complete the 100 day course due of adverse effects.  Of 22 patient completing treatment: 40.9% were rated as Excellent (>75% patient global improvement) and 27.3% were rated as good (>50%) while 22.7% failed.  No major adverse events occurred. Reductions in RMDQ, back pain, leg pain, number of days with pain and hours per day with pain were all seen, with varying statistical significance.


Retention of patients was less and overall success was les in clinical practice than in clinical trial, probably due to less stringent selection criteria but overall, sufficient levels of treatment success was achieved with acceptable side effects for the author to conclude that further exploration of MAST treatment appears justified.

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