Prospective study using anterior approach did not show association between Modic 1 changes and low grade infection in lumbar spine

Rigal, J.; Thelen, Thomas; Byrne, Fintan; Cogniet, A; Boissière, Louis; Aunoble, S.; Huec, Jean-Charles Le

doi:10.1007/s00586-016-4396-5

Cited by 55 publications

(59 citation statements)

References 34 publications

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“…On the other hand, several of the previous studies reported a low prevalence of culture-positivity in resected lumbar discs [5, 6, 10]. In this light, even if P .…”

Section: Introductionmentioning

confidence: 86%

Propionibacterium acnes biofilm is present in intervertebral discs of patients undergoing microdiscectomy

et al. 2017

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BackgroundIn previous studies, Propionibacterium acnes was cultured from intervertebral disc tissue of ~25% of patients undergoing microdiscectomy, suggesting a possible link between chronic bacterial infection and disc degeneration. However, given the prominence of P. acnes as a skin commensal, such analyses often struggled to exclude the alternate possibility that these organisms represent perioperative microbiologic contamination. This investigation seeks to validate P. acnes prevalence in resected disc cultures, while providing microscopic evidence of P. acnes biofilm in the intervertebral discs.MethodsSpecimens from 368 patients undergoing microdiscectomy for disc herniation were divided into several fragments, one being homogenized, subjected to quantitative anaerobic culture, and assessed for bacterial growth, and a second fragment frozen for additional analyses. Colonies were identified by MALDI-TOF mass spectrometry and P. acnes phylotyping was conducted by multiplex PCR. For a sub-set of specimens, bacteria localization within the disc was assessed by microscopy using confocal laser scanning and FISH.ResultsBacteria were cultured from 162 discs (44%), including 119 cases (32.3%) with P. acnes. In 89 cases, P. acnes was cultured exclusively; in 30 cases, it was isolated in combination with other bacteria (primarily coagulase-negative Staphylococcus spp.) Among positive specimens, the median P. acnes bacterial burden was 350 CFU/g (12 - ~20,000 CFU/g). Thirty-eight P. acnes isolates were subjected to molecular sub-typing, identifying 4 of 6 defined phylogroups: IA1, IB, IC, and II. Eight culture-positive specimens were evaluated by fluorescence microscopy and revealed P. acnes in situ. Notably, these bacteria demonstrated a biofilm distribution within the disc matrix. P. acnes bacteria were more prevalent in males than females (39% vs. 23%, p = 0.0013).ConclusionsThis study confirms that P. acnes is prevalent in herniated disc tissue. Moreover, it provides the first visual evidence of P. acnes biofilms within such specimens, consistent with infection rather than microbiologic contamination.

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“…On the other hand, several of the previous studies reported a low prevalence of culture-positivity in resected lumbar discs [5, 6, 10]. In this light, even if P .…”

Section: Introductionmentioning

confidence: 86%

Propionibacterium acnes biofilm is present in intervertebral discs of patients undergoing microdiscectomy

et al. 2017

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“…One rationale is that the P. acnes isolated in these cases may have been contamination rather than original growth because P. acnes is commensal flora existing on skin and it may readily contaminate the intervertebral discs during tissue harvesting [13, 14]. Another point was that some studies did not find any bacteria at all [15–17]. For example, one study covering more than 300 samples found no original growth of P. acnes in any intervertebral discs [15].…”

Section: Introductionmentioning

confidence: 99%

“…Another point was that some studies did not find any bacteria at all [15–17]. For example, one study covering more than 300 samples found no original growth of P. acnes in any intervertebral discs [15]. …”

Section: Introductionmentioning

confidence: 99%

Histological Identification ofPropionibacterium acnesin Nonpyogenic Degenerated Intervertebral Discs

Yuan

Zhou

Jiao

et al. 2017

BioMed Research International

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Purpose. Low-virulence anaerobic bacteria, especially the Propionibacterium acnes (P. acnes), have been thought to be a new pathogeny for a series of disc diseases. However, until now, there has been no histological evidence to confirm this link. The purpose of this study was to confirm the presence of P. acnes in nonpyogenic intervertebral discs via histological observation. Method. Degenerated intervertebral discs were harvested from 76 patients with low back pain and/or sciatica but without any symptoms of discitis or spondylodiscitis. The samples were cultured under anaerobic conditions and then examined using 16S rDNA PCR to screen for P. acnes. Samples found to be positive for P. acnes were stained with hematoxylin-eosin (HE) and modified Brown-Brenn staining and observed under a microscope. Results. Here, 16 intervertebral discs were found to be positive for P. acnes via 16S rDNA PCR and the prevalence was 21.05% (16/76). Among them, 7 samples had visible microbes stained with HE and modified Brown-Brenn staining. Morphological examination showed the bacteria to be Gram-positive and rod-shaped, so they were considered P. acnes. Conclusion. P. acnes is capable of colonizing some degenerated intervertebral discs without causing discitis, and its presence could be further confirmed by histological evidence. Targeting these bacteria may be a promising therapy method for some disc diseases.

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“…Rigal et al. studied 313 patients with degenerative disc disease (not herniation) and found bacteria in less than 2% with no association to Modic changes. Carricajo examined 54 patients with LDH and found the rate of positive cultures to be similar between disc samples and control samples from sourrounding muscle and ligament.…”

Section: Purpose Of the Studymentioning

confidence: 99%

“…Propionibacterium acnes is typically classified as a ubiquitous, non-pathogenic, commensal microorganism and the apparent colonization of disc tissue by P. acnes has been interpreted to be a result of contamination due to contradictory rapports. Rigal et al (6) studied 313 patients with degenerative disc disease (not herniation) and found bacteria in less than 2% with no association to Modic changes. Carricajo (7) examined 54 patients with LDH and found the rate of positive cultures to be similar between disc samples and control samples from sourrounding muscle and ligament.…”

mentioning

confidence: 99%

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

Ohrt-Nissen

Fritz

Walbom

et al. 2018

APMIS

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A relationship has been suggested between lumbar disc herniation (LDH) and chronic bacterial infection frequently involving Propionibacterium acnes, which is known to cause chronic infection through the formation of biofilm aggregates. The objective of the study was to assess whether a disc infection involving biofilm formation is present in patients with LDH. A total of 51 LDH patients and 14 controls were included. Bacterial DNA was detected by real-time polymerase chain reaction (PCR) in 16/51 samples in the LDH group and 7/14 controls (p = 0.215). Sequencing identified bacteria in 9/16 and 6/7 PCR positive samples in the LDH and control groups, respectively. All samples were stained using fluorescence in situ hybridization (FISH) and examined by confocal laser scanning microscopy. Microscopy demonstrated tissue-embedded bacterial aggregates with host inflammatory cells in 7/51 LDH patients and no controls. The presence of both bacterial aggregates and inflammatory cells suggests a chronic infection in a subset of LDH patients. The finding of bacterial 16S rDNA in both LDH and control disc tissue highlights the importance of microscopic observation to discriminate infection vs contamination. Our findings may have therapeutic implications, as the treatment of biofilm infections is different and more challenging than traditional infections.

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Prospective study using anterior approach did not show association between Modic 1 changes and low grade infection in lumbar spine

Cited by 55 publications

References 34 publications

Propionibacterium acnes biofilm is present in intervertebral discs of patients undergoing microdiscectomy

Propionibacterium acnes biofilm is present in intervertebral discs of patients undergoing microdiscectomy

Histological Identification ofPropionibacterium acnesin Nonpyogenic Degenerated Intervertebral Discs

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

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