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

Abstract

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

Histological Identification ofPropionibacterium acnesin Nonpyogenic Degenerated Intervertebral Discs

“…McLorinan et al identified P. acnes using immunofluorescence microscopy, but they found that the bacteria colonized as single cells more than in large aggregates so the immune-labeled P. acnes was attributed as contamination [13]. Recently, Coscia et al examined degenerated intervertebral discs with Gram-staining, but none of the samples had any visible microorganisms [2]. …”

Lumbar Disc Herniation

“…Furthermore, long-term antibiotics targeting anaerobes may improve lower back pain in those with disc herniation and vertebral edema [22]. Despite this, however, other studies have failed to correlate P. acnes prevalence with LDH pathology [29]. While it is likely that P. acnes may play a role in LDH symptomology and ultimately be a target for non-operative treatment, further research must be done to elucidate the measure of effect this bacteria has on symptomatic LDH.…”

Bacterial biofilms: a possible mechanism for chronic infection in patients with lumbar disc herniation – a prospective proof‐of‐concept study using fluorescence in situ hybridization

“…These findings are in line with the microscopy results of the current study. Staphylococcus , specifically S. epidermis is one of the most prevalent organisms cultured from LDH . Given the high prevalence of S. epidermidis by PCR in the current study, it is not unlikely that the aggregates observed in Figs and may be S. epidermidis .…”

“…Coscia et al. examined a large series of patients using light microscopy of gram‐stained formalin‐fixated tissue section. The study found no evidence of microorganisms or chronic inflammation.…”

“…However, the bacteria appeared as single cells instead of aggregates, indicating contamination as the most likely mechanism. Coscia et al (5) examined a large series of patients using light microscopy of gram-stained formalin-fixated tissue section. The study found no evidence of microorganisms or chronic inflammation.…”