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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.
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.
Objective. The purpose was to compare the clinical effects of posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of lumbar disc herniation (LDH) complicated with spinal stenosis. Methods. 96 LDH patients complicated with spinal stenosis treated in our hospital (April 2018–April 2020) were chosen as the subjects, and split into the PLIF group and the TLIF group according to different surgical approaches, with 48 cases in each group. The clinical effects of the two groups were compared. Results. There was no significant difference in hospitalization time between the two groups ( P > 0.05 ). Compared with the PLIF group, the TLIF group had obviously shorter operation time and greatly lesser intraoperative blood loss ( P < 0.05 ). The Numerical Rating Scale (NRS) scores of lower limb pain and low back pain in the two groups at 3 months after surgery were significantly lower than those before surgery ( P < 0.001 ). The Japanese Orthopaedic Association (JOA) scores of the two groups at 3 months after surgery were significantly higher than those before surgery ( P < 0.001 ). The Spitzer Quality of Life Index (SQLI) scores of the two groups at 3 months after surgery were significantly higher than those before surgery ( P < 0.001 ). Conclusion. The two surgical approaches have similar efficacy in treating LDH complicated with spinal stenosis. However, PLIF is better than TLIF in terms of operation time and intraoperative blood loss, which should be adopted as the preferred surgical scheme.
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