Association Between Lumbar Disc Degeneration and Propionibacterium acnes Infection

Li, Bo; Dong, Zhe; Wu, Yongchao; Ji, Zeng; Zheng, Qiang; Xiao, Bokui; Cai, Xianyi; Xiao, Zhiyong

doi:10.1097/brs.0000000000001383

Cited by 32 publications

(33 citation statements)

References 28 publications

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“…Nevertheless, it is the most commonly used in P. acnes studies . While intravenous injected strain type IA did not home to a herniated discs in a rabbit model, it remains to be determined whether this is also true for P. acnes type 2. The presented model allows now to investigate the clinical relevance of the different strains.…”

Section: Discussionmentioning

confidence: 99%

“…TLR2 ligation in disc cells triggers IL‐1/‐6/‐8, COX‐2, MMP‐3, and MMP‐13 production, which aggravate disc degeneration and induce the release of chemokines . The degenerative effects of P. acnes on discs was demonstrated in a rabbit disc herniation model, where P. acnes were injected into discs …”

Section: Discussionmentioning

confidence: 99%

“…In contrast, strain type IA is abundant on the skin and expresses considerably lower levels of some virulence factors, which likely lowers the potential to trigger MC1 . Nevertheless, it is the most commonly used in P. acnes studies . While intravenous injected strain type IA did not home to a herniated discs in a rabbit model, it remains to be determined whether this is also true for P. acnes type 2.…”

Section: Discussionmentioning

confidence: 99%

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Propionibacterium acnes infected intervertebral discs cause vertebral bone marrow lesions consistent with Modic changes

Dudli

Liebenberg

Magnitsky

et al. 2016

Journal Orthopaedic Research

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Modic type I change (MC1) are vertebral bone marrow lesions adjacent to degenerated discs that are specific for discogenic low back pain. The etiopathogenesis is unknown, but occult discitis, in particular with Propionibacteria acnes (P. acnes), has been suggested as a possible etiology. If true, antibiotic therapy should be considered for patients with MC1. However, this hypothesis is controversial. While some studies report up to 40% infection rate in herniated discs, others fail to detect infected discs and attribute reports of positive cultures to contamination during sampling procedure. Irrespective of the clinical controversy, whether it is biologically plausible for P. acnes to cause MC1 has never been investigated. Therefore, the objective of this study was to test if P. acnes can proliferate within discs and cause reactive changes in the adjacent bone marrow. P. acnes was aseptically isolated from a symptomatic human L4/5 disc with MC1 and injected into rat tail discs. We demonstrate proliferation of P. acnes and up-regulation of IL-1 and IL-6 within three days of inoculation. At day-7, disc degeneration was apparent along with fibrotic endplate erosion. TNF-a immunoreactivity was enhanced within the effected endplates along with cellular infiltrates. The bone marrow appeared normal. At day-14, endplates and trabecular bone close to the disc were almost completely resorbed and fibrotic tissue extended into the bone marrow. T-cells and TNF-a immunoreactivity were identified at the disc/marrow junction. On MRI, bone marrow showed MC1-like changes. In conclusion, P. acnes proliferate within the disc, induce degeneration, and cause MC1-like changes in the adjacent bone marrow. ß

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Propionibacterium acnes infected intervertebral discs cause vertebral bone marrow lesions consistent with Modic changes

Dudli

Liebenberg

Magnitsky

et al. 2016

Journal Orthopaedic Research

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“…of 11 published studies on this topic. They found: “moderate evidence to indicate low virulent bacteria have a role in low back pain with disc herniation and moderate evidence for a relationship between bacteria and Modic Type I change associated with disc herniation.” 3 37 38 Li et al 39 . attempted to address these issues with a combined human/rabbit study.…”

Section: Discussionmentioning

confidence: 99%

“…attempted to address these issues with a combined human/rabbit study. The human component showed growth in only three of 30 discs (cultured for 10 days), none P. acnes ; the rabbits verified that “ P. acnes could infect the degenerated lumbar discs by way of bacteremia.” 39 Finally, a recent editorial addressing the present understanding of spondyloarthritis and gut microbiota noted that evaluating, and trying to modulate gut microbiota is a very complex undertaking; however, various rheumatologic conditions may be associated with distinct bacterial profiles 40 …”

Section: Discussionmentioning

confidence: 99%

Propionibacterium acnes, Coagulase-Negative Staphylococcus, and the “Biofilm-like” Intervertebral Disc

Coscia

Denys

Wack

2016

Spine

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Study Design.Patients scheduled for spinal surgery were screened prospectively for a microbial presence associated with intervertebral disc specimens. Inclusion was limited to patients requiring surgery for any of five conditions: study patients with cervical spine intervertebral herniation (IVH), lumbar spine IVH, lumbar spine discogenic pain, and control patients with idiopathic scoliosis/Scheurermann's kyphosis or trauma/neuromuscular deformity. Exclusion criteria included ongoing systemic infection, abnormal pre-operative white cell counts, documented or suspected spinal infection, or previous surgery to the involved disc.Objective.The aim of this study was to test for an association between the presence of a bacterial entity in operated discs and a diagnosis of pathologic disc disease.Summary of Background Data.An association has been described between microbial colonization and progressive intervertebral disc degeneration in 36 herniation patients undergoing microdiscectomies. A total of 19 patients had positive cultures on long-term incubation, with Propionibacterium acnes present in 84% of discs.Materials and Methods.Discs were harvested during surgery, using strict sterile technique. Each disc was divided, with half the sample sealed in a sterile, commercially prepared anaerobic culture transport container, and half fixed in formalin. Live specimens were cultured for bacteria at a university-affiliated laboratory in a blinded fashion. Fixed pathologic specimens were gram-stained and read by a board-certified pathologist.Results.A total of 169 intervertebral discs from 87 patients were evaluated (46 males, 41 females). Positive cultures were noted in 76 of 169 discs (45%), with 34 discs positive for P. acnes and 30 discs positive for Staphylococcus. No pathologic evidence was seen of microorganisms, acute or chronic inflammation, or infection. Pooling the IVH and discogenic pain patients and contrasting them with control patients showed a significant association of IVH with positive bacterial cultures (χ 2 = 15.37; P = 0.000088).Conclusion.Endemic bacterial biofilms are significantly associated with IVH and discogenic pain. Level of Evidence: N/A

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The association between low virulence organisms in different locations and intervertebral disc structural failure: A meta‐analysis and systematic review

Chen

Chopra

et al. 2023

JOR Spine

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Many factors may trigger intervertebral disc (IVD) structural failure (intervertebral disc degeneration (IDD) and endplate changes), including inflammation, infection, dysbiosis, and the downstream effects of chemical factors. Of these, microbial diversity in the IVD and elsewhere in the body has been considered as one of the potential reasons for disc structural failure. The exact relationships between microbial colonization and IVD structural failure are not well understood. This meta‐analysis aimed to investigate the impact of microbial colonization and its location (such as skin, IVD, muscle, soft tissues, and blood) on IVD structural failure and corresponding low back pain (LBP) if any. We searched four online databases for potential studies. The potential relationships between microbial colonization in different sample sources (such as skin, IVD, muscle, soft tissues, and blood) and IDD and endplate change were considered as primary outcomes. Odds ratio (OR) and 95% confidence intervals (CI) for direct comparisons were reported. Grading of Recommendations Assessment, Development and Evaluation (GRADE) scale was used to assess the quality of evidence. Twenty‐five cohort studies met the selection criteria. Overall pooled prevalence of microbial colonization in 2419 patients with LBP was 33.2% (23.6%–43.6%). The pooled prevalence of microbial colonization in 2901 samples was 29.6% (21.0%–38.9%). Compared with the patients without endplate change, the patients with endplate changes had higher rates of microbial colonization of disc (OR = 2.83; 95% CI = 1.93–4.14; I2 = 37.6%; p = 0.108). The primary pathogen was Cutibacterium acnes which was present in 22.2% of cases (95% CI = 13.3%–32.5%; I2 = 96.6%; p = 0.000). This meta‐analysis and systematic review found low‐quality grade evidence for an association between microbial colonization of disc with endplate changes. The primary pathogen was C. acnes. Due to lack of enough high‐quality studies and methodological limitations of this review, further studies are required to improve our understanding of the potential relationships and mechanisms of microbiota, dysbiosis, IVD colonization and IVD structural failure.

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Association Between Lumbar Disc Degeneration and Propionibacterium acnes Infection

Abstract: N/A.

Cited by 32 publications

References 28 publications

Propionibacterium acnes infected intervertebral discs cause vertebral bone marrow lesions consistent with Modic changes

Propionibacterium acnes infected intervertebral discs cause vertebral bone marrow lesions consistent with Modic changes

Propionibacterium acnes, Coagulase-Negative Staphylococcus, and the “Biofilm-like” Intervertebral Disc

The association between low virulence organisms in different locations and intervertebral disc structural failure: A meta‐analysis and systematic review

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