Abstract
BackgroundThe local infectious origin and the putative role of Cutibacterium acnes (CA) of a particular subtype of discopathy (Modic 1) are still debated.PurposeTo establish the association of CA in intervertebral disc (IVD) and Modic 1 discopathy in patients with low back pain.MethodsThe prevalence of bacteria in IVD samples obtained by anterior approach in patient with chronic low back pain harboring Modic type 1, 2 or no Modic changes was compared to that measured in IVD samples obtained by posterior approach for sciatica. From 45 patients included in the study, 77 discs samples were obtained: 58 by anterior approach (32 Modic 1/2 changes, 26 without Modic change) and 19 by posterior approach. Conventional microbial cultures, universal 16S rRNA molecular detection and a CA specific PCR were performed.Results12 /77 (15.6%) disc samples were culture positive. Among the 10 CA positive cultures, 5 out of 58 (8.6%) were identified from specimens obtained by anterior approach and 5/19 (26.3%) from posterior approach (p = 0.046). Moreover, the percentage of CA culture positive sample was statistically no different between the patient with or without Modic changes. The CA prevalence was lower through molecular, culture—free approaches: the universal 16S rRNA PCR was positive for 6 specimens, including one CA positive sample and the CA specific PCR was positive for one specimen obtained by posterior approach.ConclusionsIn spine surgery the prevalence of CA in culture was significantly higher in IVD samples collected through a posterior approach compared to an anterior approach, suggesting a contamination process. This study did not support the CA related local infectious origin of Modic 1 discopathy.
Highlights
Low back pain (LBP) is the 20th century disease, mentioned as the first cause of survival with handicap among 288 other diseases in a recent worldwide review [1]
The prevalence of bacteria in intervertebral disc (IVD) samples obtained by anterior approach in patient with chronic low back pain harboring Modic type 1, 2 or no Modic changes was compared to that measured in IVD samples obtained by posterior approach for sciatica
In spine surgery the prevalence of Cutibacterium acnes (CA) in culture was significantly higher in IVD samples collected through a posterior approach compared to an anterior approach, suggesting a contamination process
Summary
Low back pain (LBP) is the 20th century disease, mentioned as the first cause of survival with handicap among 288 other diseases in a recent worldwide review [1]. Other studies supported these findings: the reported prevalence of bacteria in the disc and the predominance of CA as the mains bacteria varied from 19% to 71% and from 13% to 38%, respectively [9,10] Based on this infectious hypothesis, a long-term antibiotic therapy targeting CA in LBP was tested in the context of Modic 1, inducing a significant improvement on pain and on different scales compared to placebo [11,12]. This randomized placebo controlled trial results in a high media resonance. To establish the association of CA in intervertebral disc (IVD) and Modic 1 discopathy in patients with low back pain
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