Bacteriologic Culture of Excised Intervertebral Disc From Immunocompetent Patients Undergoing Single Level Primary Lumbar Microdiscectomy

Agarwal, Vijay; Golish, S. Raymond; Alamin, Todd F.

doi:10.1097/bsd.0b013e3182019f3a

Cited by 67 publications

(53 citation statements)

References 29 publications

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“…The current study confirms the findings of other studies [10,11,[27][28][29] where the microorganism most frequently found in the extruded nucleus material is P. acnes, accounting for approximately 80 % of the positive cases. The predominance of P. acnes might reflect the unusual environment in the disc where the lack of vascularity results in a very low oxygen tension and a low pH which provides ideal conditions for low virulent anaerobic bacteria to grow.…”

Section: Discussionsupporting

confidence: 92%

“…In 30 cervical disc herniations they found that 59 % had microorganisms present, 37 % with P. acnes. Agarwal et al [28] similarly cultured material excised from 52 patients treated with a single-level microdiscectomy for lumbar disc herniation. Ten (19 %) of the patients had microorganisms present and in 7 (70 %) of those, P. acnes was the sole microorganism isolated.…”

Section: Discussionmentioning

confidence: 99%

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Does nuclear tissue infected with bacteria following disc herniations lead to Modic changes in the adjacent vertebrae?

et al. 2013

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Purpose To investigate the prevalence of infected herniated nucleus material in lumbar disc herniations and to determine if patients with an anaerobic infected disc are more likely to develop Modic change (MC) (bone oedema) in the adjacent vertebrae after the disc herniation. MCs (bone oedema) in vertebrae are observed in 6 % of the general population and in 35-40 % of people with low back pain. These changes are strongly associated with low back pain. There are probably a mechanical cause and an infective cause that causes MC. Several studies on nuclear tissue from herniated discs have demonstrated the presence of low virulent anaerobic microorganisms, predominantly Propionibacterium acnes, in 7-53 % of patients. At the time of a herniation these low virulent anaerobic bacteria may enter the disc and give rise to an insidious infection. Local inflammation in the adjacent bone may be a secondary effect due to cytokine and propionic acid production. Methods Patients undergoing primary surgery at a single spinal level for lumbar disc herniation with an MRI-confirmed lumbar disc herniation, where the annular fibres were penetrated by visible nuclear tissue, had the nucleus material removed. Stringent antiseptic sterile protocols were followed. Results Sixty-one patients were included, mean age 46.4 years (SD 9.7), 27 % female. All patients were immunocompetent. No patient had received a previous epidural steroid injection or undergone previous back surgery. In total, microbiological cultures were positive in 28 (46 %) patients. Anaerobic cultures were positive in 26 (43 %) patients, and of these 4 (7 %) had dual microbial infections, containing both one aerobic and one anaerobic culture. No tissue specimens had more than two types of bacteria identified. Two (3 %) cultures only had aerobic bacteria isolated. In the discs with a nucleus with anaerobic bacteria, 80 % developed new MC in the vertebrae adjacent to the previous disc herniation. In contrast, none of those with aerobic bacteria and only 44 % of patients with negative cultures developed new MC. The association between an anaerobic culture and new MCs is highly statistically significant (P = 0.0038), with an odds ratio of 5.60 (95 % CI 1.51-21.95). Conclusion These findings support the theory that the occurrence of MCs Type 1 in the vertebrae adjacent to a previously herniated disc may be due to oedema surrounding an infected disc. The discs infected with anaerobic bacteria were more likely (P \ 0.0038) to develop MCs in the adjacent vertebrae than those in which no bacteria were found or those in which aerobic bacteria were found.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Does nuclear tissue infected with bacteria following disc herniations lead to Modic changes in the adjacent vertebrae?

et al. 2013

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“…Some authors found that disc infection due to P. acnes would initiate sciatica [2] or Modic changes [5] but others did not [24,25]. In this study, we found that the prevalence of sciatica was significantly higher in patients with annular tear than those without annular tear.…”

Section: Discussionsupporting

confidence: 62%

“…There are inconsistent results regarding the association between disc infection and development of symptoms [2,5,24]. Some authors found that disc infection due to P. acnes would initiate sciatica [2] or Modic changes [5] but others did not [24,25].…”

Section: Discussionmentioning

confidence: 92%

“…P. acnes was found in the discs in onethird of patients with visible annular tear, but not seen in the discs without annular tear, suggesting that the breach in outer annulus is a key determinant for P. acnes accessing the disc. It has been reported that disc infection occurs not only in patients with disc herniation, but also in patients with previous spinal surgeries or intraspinal injection [6,24], both of which may cause damage of the outer annulus. Data expressed as number (percent) Fig.…”

Section: Discussionmentioning

confidence: 98%

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