Abstract
The anaerobic bacterium Cutibacterium acnes has been increasingly linked to the development of degenerative disc disease (DDD), although causality is yet to be conclusively proven. To better study how this organism could contribute to the aetiology of DDD, improved animal models that are more reflective of human disc anatomy, biology and mechanical properties are required. Against this background, our proof-of concept study aimed to be the first demonstration that C. acnes could be safely administered percutaneously into sheep intervertebral discs (IVDs) for in vivo study. Following our protocol, two sheep were successfully injected with a strain of C. acnes (8.3 × 106 CFU/disc) previously recovered from a human degenerative disc. No adverse reactions were noted, and at one-month post inoculation all triplicate infected discs in our first animal grew C. acnes, albeit at a reduced load (5.12 × 104 to 6.67 × 104 CFU/disc). At six months, no growth was detected in discs from our second animal indicating bacterial clearance. This pilot study has demonstrated the feasibility of safe percutaneous injection of C. acnes into sheep IVDs under fluoroscopic guidance. The design of follow-up sheep studies to investigate the potential of C. acnes to drive pathological changes within infected discs should now be pursued.
Highlights
According to the Global Burden of Disease study of 2017, low back pain (LBP) is the world’s leading cause of disability [1]
Over the last 20 years, evidence has accumulated to suggest that infection of intervertebral discs (IVDs) especially with the anaerobic bacterium Cutibacterium acnes may have an important role to play in the development of degenerative disc disease (DDD) and discogenic pain [4,5,6,7,8,9,10,11,12,13,14]
The objective of this proof-of-concept study was to demonstrate that percutaneous inoculation of sheep lumbar IVDs with C. acnes can be performed safely and is a feasible approach for future investigations
Summary
According to the Global Burden of Disease study of 2017, low back pain (LBP) is the world’s leading cause of disability [1]. Over the last 20 years, evidence has accumulated to suggest that infection of IVDs especially with the anaerobic bacterium Cutibacterium acnes (previously Propionibacterium acnes) may have an important role to play in the development of DDD and discogenic pain [4,5,6,7,8,9,10,11,12,13,14] This organism, which is a substantial component of the normal microbiota on human skin, is a low-grade opportunistic pathogen most famously described for its association with the inflammatory skin condition acne vulgaris [15]. It has been reported that human IVDs associated with
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