Up to 40 per cent of patients with chronic back pain could be cured with a course of antibiotics rather than surgery, in a medical breakthrough that one spinal surgeon says is worthy of a Nobel prize.
Surgeons are reviewing how they treat patients with chronic back pain after scientists discovered that many of the worst cases were due to bacterial infections.
The shock finding means that scores of patients with unrelenting lower back pain will no longer face major operations but can instead be cured with courses of antibiotics costing around £114 (HK$1,370).
One of Britain's most eminent spinal surgeons said the discovery was the greatest he had witnessed in his professional life, and that its impact on medicine was worthy of a Nobel prize.
"This is vast. We are talking about probably half of all spinal surgery for back pain being replaced by taking antibiotics," said Peter Hamlyn, a consultant neurological and spinal surgeon at University College London hospital.
Specialists have long known that infections are sometimes to blame, but these cases were thought to be exceptional. That thinking has been overturned by scientists at the University of Southern Denmark, who found that 20 to 40 per cent of chronic lower back pain was caused by bacterial infections.
"This will not help people with normal back pain, those with acute, or sub-acute pain - only those with chronic lower back pain," said Dr Hanne Albert, of the Danish team. "These are people who live a life on the edge because they are so handicapped with pain. We are returning them to a form of normality they would never have expected."
The Danish team describes their work in two papers published in the European Spine Journal. The first report explains how bacterial infections inside slipped discs can cause painful inflammation and tiny fractures in the surrounding vertebrae.
In the second paper, the scientists proved they could cure chronic back pain with a 100-day course of antibiotics. In a random trial, the drugs reduced pain in 80 per cent of patients who had suffered for more than six months and had signs of damaged vertebra under MRI scans.
Albert stressed antibiotics would not work for all back pain.