Abstract
BackgroundThe existence of latent low-virulence anaerobic bacteria in degenerated intervertebral discs (IVDs) remains controversial. In this study, the prevalence of low-virulence anaerobic bacteria in degenerated IVDs was examined, and the correlation between bacterial infection and clinical symptoms was analysed.MethodsEighty patients with disc herniation who underwent discectomy were included in this study. Under a stringent protocol to ensure sterile conditions, 80 disc samples were intraoperatively retrieved and subjected to microbiological culture. Meanwhile, tissue samples from the surrounding muscle and ligaments were harvested and cultured as contamination markers. The severity of IVD degeneration and the prevalence of Modic changes (MCs) were assessed according to preoperative MRI analysis.ResultsOf the 80 cultured discs, 54 were sterile, and 26 showed the presence of bacteria: Propionibacterium acnes (21 cases) and coagulase-negative staphylococci (5 cases). MRI revealed that the presence of bacteria was significantly associated with MCs (P<0.001). However, there was no significant association between bacterial infection and the severity of IVD degeneration (P = 0.162).ConclusionsOur findings further validated the presence of low-virulence anaerobic bacteria in degenerated IVDs, and P. acnes was the most frequent bacterium. In addition, the latent infection of bacteria in IVDs was associated with Modic changes. Therefore, low-virulence anaerobic bacteria may play a crucial role in the pathophysiology of MCs and lumbar disc herniation.
Highlights
The existence of latent low-virulence anaerobic bacteria in degenerated intervertebral discs (IVDs) remains controversial
Stirling et al performed microbiological culturing of intervertebral disc material from 36 patients who underwent micro-discectomy for severe sciatica and found that 53% were positive for Propionibacterium acnes [3]
A recent RCT demonstrated that antibiotic treatment was effective for the treatment of chronic low back pain, implying that disc herniation could be secondary to infection [5]
Summary
The existence of latent low-virulence anaerobic bacteria in degenerated intervertebral discs (IVDs) remains controversial. While radicular symptoms are often related to nerve root compression by a prolapsed disc, it is not uncommon to observe a discrepancy between the degree of disc prolapse and pain severity [2]. This incongruity between clinical symptoms and imaging findings is likely. Serological testing of 140 patients with sciatica revealed that 31% had increased titres of serum immunoglobulin G to the lipid S antigen. Their findings suggested that microbial infection could be responsible for sciatica in disc herniation. A recent RCT demonstrated that antibiotic treatment was effective for the treatment of chronic low back pain, implying that disc herniation could be secondary to infection [5]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
