Association between sciatica and Propionibacterium acnes

Stirling, Allan; Worthington, Tony; Rafiq, Mohammed; Lambert, Peter A.; Elliott, Tom

doi:10.1016/s0140-6736(00)05109-6

Cited by 267 publications

(281 citation statements)

References 4 publications

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“…Low-grade bacterial infection (Propionibacterium acnes) might play a role in sciatica [59,60]. It is reported that antibiotics improve backaches and disabilities [21].…”

Section: Bacterial Infection As a Factormentioning

confidence: 99%

New concept for backache: biopsychosocial pain syndrome

Kikuchi

2008

Eur Spine J

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Recently a new concept for explaining backache, ''biopsychosocial pain syndrome,'' has been suggested. Psychosocial factors play an important role in the development and persistence of backache from an early stage. Diagnosis and treatment of backache should be based on the new concept. A good relationship between doctors and patients influences treatment outcome and patient satisfaction. Treatment should be decided by patients themselves, after being informed of the natural history of the disease and the merit and demerit of the treatment.

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“…Low-grade bacterial infection (Propionibacterium acnes) might play a role in sciatica [59,60]. It is reported that antibiotics improve backaches and disabilities [21].…”

Section: Bacterial Infection As a Factormentioning

confidence: 99%

New concept for backache: biopsychosocial pain syndrome

Kikuchi

2008

Eur Spine J

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“…hypothesized that Propionibacterium acnes could be responsible for sciatica in patients with disc herniation, and reported a high number of positive cases using serology and culturing [32].…”

Section: Introductionmentioning

confidence: 99%

Detection of bacterial DNA in painful degenerated spinal discs in patients without signs of clinical infection

2004

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A local inflammatory and potentially painful response, of which the ultimate cause is unknown, has been described in nervous tissues in contact with degenerated disc material in patients with low back and leg pain. With the rationale that a possible cause of such inflammation could be bacterial infection, we utilized PCR (polymerase chain reaction) amplification of the 16S rRNA (ribosomal RNA) gene followed by gene sequencing, to investigate whether bacterial DNA might be detected in the degenerative discs of 10 patients operated for disc herniation or post-discectomy syndrome. One patient with disc hernia harbored DNA homologous to Bacillus cereus, and in one patient suffering from post-discectomy syndrome, Citrobacter braakilfreundii DNA was detected. The finding demonstrates that 16S rRNA PCR can be a useful tool in search of bacterial DNA in degenerated discs, which in turn may be indicative of low-grade infection, manifesting itself only as pain rather than as clinical infection.

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“…The story starts in 2001 with the publication of a research letter in the Lancet by a group from Birmingham [3] demonstrating that 31 % of patients with sciatica tested positive to a newly developed serological test, which diagnosed deep-seated infections caused by virulent Grampositive microorganisms. In addition, intervertebral disc material excised during microdiscectomy in a different group of patients, which was cultured in a specialist anaerobic environment, had positive cultures after longterm incubation in 53 % of patients and of this group 84 % grew Propionibacterium acnes.…”

Section: The Factsmentioning

confidence: 99%

Antibiotics a cure for back pain, a false dawn or a new era?

O’Dowd

Casey

2013

Eur Spine J

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The recent publication in this journal of papers by Albert and colleagues [1,2] from Denmark suggesting that low grade anaerobic bacterial infection may be the underlying cause of significant persistent chronic back pain in a welldefined group of patients has precipitated an unprecedented response in the medical and lay media. In the midst of claim and counterclaim, these studies represent a significant and substantial change in our understanding of the pathophysiology of back pain in some patient groups, and the importance of this should not be lost amidst the negative, unstructured and unscientific response to this study. The factsThe story starts in 2001 with the publication of a research letter in the Lancet by a group from Birmingham [3] demonstrating that 31 % of patients with sciatica tested positive to a newly developed serological test, which diagnosed deep-seated infections caused by virulent Grampositive microorganisms. In addition, intervertebral disc material excised during microdiscectomy in a different group of patients, which was cultured in a specialist anaerobic environment, had positive cultures after longterm incubation in 53 % of patients and of this group 84 % grew Propionibacterium acnes.Following the ISSLS 2006 meeting, a collaboration developed between the Birmingham group and the group from Southern Denmark. This led to publication of a pilot study in 2008 [4] where 32 chronic low back pain patients with Modic type 1 endplate changes and a previous lumbar herniated disc were treated with amoxicillin and clavulanate for 90 days. In this uncontrolled trial, there was a clinically important and statistically significant difference in outcome at 10-month follow-up following antibiotic treatment.In the meantime, the evidence was accumulating about the significant correlation between Modic endplate changes and back pain. Albert and Manniche [5] identified a strong association between Modic changes and non-specific low back pain, a stronger association with Modic type 1 than type 2, and that a lumbar disc herniation is a strong risk factor for developing Modic changes, especially type 1, during the following year and that these changes are strongly associated with low back pain.A systematic review from Southern Denmark in 2008 [6] identified the prevalence of vertebral endplate signal changes as 43 % in patients with non-specific low back pain and/or sciatica, and 6 % in a non-clinical population, demonstrating that endplate changes are associated with pain. A further systematic review in the same year from Shanghai [7] identified two possible pathophysiological mechanisms for Modic changes-one biomechanical and one biochemical. A biomechanical pathway for development of Modic changes was supported by a large population MRI scan study in 2011 [8].Against this background two key papers were then published in this journal in 2013. In one study [2] Albert and colleagues established a strong relationship between

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Association between sciatica and Propionibacterium acnes

Cited by 267 publications

References 4 publications

New concept for backache: biopsychosocial pain syndrome

New concept for backache: biopsychosocial pain syndrome

Detection of bacterial DNA in painful degenerated spinal discs in patients without signs of clinical infection

Antibiotics a cure for back pain, a false dawn or a new era?

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