Degenerate-disc infection study with contaminant control (DISC): a multicenter prospective case-control trial

Rao, Prashanth J.; Maharaj, Monish; Chau, Christine; Taylor, Peter; Phan, Kevin; Choy, Wen Jie; Scherman, Daniel; Mews, Peter; Scholsem, Martin; Coughlan, Marc; Mobbs, Ralph J.

doi:10.1016/j.spinee.2020.03.013

Cited by 15 publications

(23 citation statements)

References 25 publications

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“…C. acnes specific culturing may explain why discs removed from patients with previous and more extensive surgery had higher rates of positive bacterial culture [58]. Moderately high rates of positive bacterial samples were obtained from discs (17%), (comparable with other studies reporting disc bacteria; see Table 1.), yet almost half muscle control specimens were positive for bacteria [58]. No bacterial differences were found between case degenerate and control discs [58].…”

Section: Discussionsupporting

confidence: 66%

“…The largest disc infection investigation to date collected samples from 812 participants. Contamination (muscle) control samples along with disc samples were taken from disc degenerative (case) and non-degenerative (control) participants [ 58 ]. Significantly higher rates of bacteria were cultured from control group samples of muscle and disc (48%) than degenerate disc samples (17%) [ 58 ].…”

Section: Resultsmentioning

confidence: 99%

“…Contamination (muscle) control samples along with disc samples were taken from disc degenerative (case) and non-degenerative (control) participants [ 58 ]. Significantly higher rates of bacteria were cultured from control group samples of muscle and disc (48%) than degenerate disc samples (17%) [ 58 ]. Prior surgeries and multilevel surgeries were associated with higher rates of bacterial growth [ 58 ].…”

Section: Resultsmentioning

confidence: 99%

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Evidence for infection in intervertebral disc degeneration: a systematic review

et al. 2021

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Purpose Back pain is a major problem worldwide and is linked to intervertebral disc degeneration and Modic change. Several studies report growth of bacteria following extraction of degenerate discs at spine surgery. A pathophysiological role for infection in back pain has been proposed. Method We conducted a PRISMA systematic review. MEDLINE, PubMed, Scopus and Web of Science were searched with the terms Modic change, intervertebral dis*, bacteria, microb*, and infect*. Date limits of 2001–2021 were set. Human studies investigating the role of bacteria in disc degeneration or Modic change in vertebrae were included. Results Thirty-six articles from 34 research investigations relating to bacteria in human degenerate discs were found. Cutibacterium acnes was identified in pathological disc material. A ‘candidate bacterium’ approach has been repeatedly adopted which may have biased results to find species a priori, with disc microbial evidence heavily weighted to find C. acnes. Conclusion Evidence to date implicates C. acnes identified through culture, microscopy and sequencing, with some suggestion of diverse bacterial colonisation in the disc. This review found studies which used culture methods and conventional PCR for bacterial detection. Further agnostic investigation using newer methods should be undertaken.

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Section: Discussionsupporting

confidence: 66%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Evidence for infection in intervertebral disc degeneration: a systematic review

et al. 2021

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“…All M6-C disc retrievals showed evidence of wear and there was Propionibacterium acnes detected. A subsequent study by Mobbs suggest this may have been a contaminant [32].…”

Section: Discussionmentioning

confidence: 92%

“…The retrieval analysis revealed macroscopic disc failure and histologic evidence of wear induced osteolysis around the revised M6-C prosthesis raising significant concerns regarding durability of this device. Bacteriological contamination was not detected [32].…”

Section: Methodsmentioning

confidence: 96%

Midterm osteolysis-induced aseptic failure of the M6-C™ cervical total disc replacement secondary to polyethylene wear debris

2022

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Background According to published meta-analyses, cervical total disc replacement (CTDR) seems to be superior to anterior cervical decompression and fusion (ACDF) in most clinical parameters. Despite short-term clinical success of CTDR, there are concerns regarding long-term durability of these prostheses. Methods This prospective study involved 382 patients who received standalone CTDR or a hybrid procedure (ACDF/CTDR). A retrospective comparison between different CTDR devices was conducted regarding patient-reported outcome measures (PROMs), failure scenarios, and revision surgeries. The M6-C™ Artificial Cervical Disc (Orthofix, Lewisville, Texas) cohort was compared to the other CTDR devices clinically. Etiological reasons for revision, and the surgical technique of the revision was investigated. Results Fifty-three patients received M6-C CTDR. Eighteen patients (34%) were revised at an average of 67 months postoperatively for wear-induced osteolysis. There were three additional cases of pending revision. The PROMs of the two groups were similar, indicating that the failure mode (wear-induced osteolysis) is often asymptomatic. The demographics of the two groups were also similar, with more women undergoing revision surgery than men. There were three one-level CTDR, four two-level hybrids, seven three-level hybrids, and three four-level hybrids revised anteriorly. Sixteen patients underwent removal of the prosthesis and were treated according to the extent of osteolysis. There were four vertebrectomies, six revisions to ACDF, and six revisions to another CTDR. One patient underwent supplemental fixation using a posterior approach. The other CTDR cohort had an incidence of 3.3% at the equivalent time, and none of these were due to osteolysis or wear-related events. Conclusions There is a concerning midterm failure rate related to ultra-high-molecular-weight-polyethylene wear-induced osteolysis in the M6-C. Patients implanted with the M6-C prosthesis should be contacted, informed, and clinically and radiologically assessed.

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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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Degenerate-disc infection study with contaminant control (DISC): a multicenter prospective case-control trial

Cited by 15 publications

References 25 publications

Evidence for infection in intervertebral disc degeneration: a systematic review

Evidence for infection in intervertebral disc degeneration: a systematic review

Midterm osteolysis-induced aseptic failure of the M6-C™ cervical total disc replacement secondary to polyethylene wear debris

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

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