THE ROLE OF INFECTION AND INFLAMMATION IN INTERVERTEBRAL DISC DEGENERATION

Abstract

Objective. To analyze the frequency and types of microbial infection of the intervertebral disc in degenerative diseases of the spine and to compare the obtained data with the results of pathohistological, X-ray and MRI studies to determine tactical approaches to surgical interventions on the spine. Material and Methods . The study was performed in 97 patients who underwent surgical treatment for degenerative spine disease. Discectomy was performed in 48 patients, and single- or multilevel decompression and stabilization in 49. Microbiological (117 samples) and pathohistological (73 samples) studies of disc material, clinical and neurological examinations of patients, and evaluation of X-ray and MRI findings were carried out. Results. Bacterial culture of the disc material was positive in 27.0 % of cases of discectomy and in 30.6 % of decompression and stabilization cases. The most frequent pathogens were obligate-anaerobic gram-positive bacteria (P. acnes) and epidermal staphylococci (S. epidermidis), in 42.8 % and 31.4 % of cases, respectively. The mixed microflora was detected in 20.0 % of observations. Pathohistological study revealed the signs of chronic inflammation in 42.8 % of patients with disc infection and in 5.7 % of patients without infection. There was no significant correlation between infection of the disc and chronic diseases, clinical manifestations, sequester, Modic type 1 changes in MRI, segment instability, and changes in CT. Conclusion . The probability of disc infection is higher in repeated operations and in degenerative lesion of discs with pain and radicular syndrome. The most reliable mechanism of intervertebral disc infection is the theory of microbial biofilms.