The Prevalence of Bacterial Infection in Patients Undergoing Elective ACDF for Degenerative Cervical Spine Conditions: A Prospective Cohort Study With Contaminant Control

Abstract

Study Design: Prospective cohort study. Objectives: To determine the prevalence of bacterial infection, with the use of a contaminant control, in patients undergoing anterior cervical discectomy and fusion (ACDF). Methods: After institutional review board approval, patients undergoing elective ACDF were prospectively enrolled. Samples of the longus colli muscle and disc tissue were obtained. The tissue was then homogenized, gram stained, and cultured in both aerobic and anaerobic medium. Patients were classified into 4 groups depending on culture results. Demographic, preoperative, and postoperative factors were evaluated. Results: Ninety-six patients were enrolled, 41.7% were males with an average age of 54 ± 11 years and a body mass index of 29.7 ± 5.9 kg/m2. Seventeen patients (17.7%) were considered true positives, having a negative control and positive disc culture. Otherwise, no significant differences in culture positivity was found between groups of patients. However, our results show that patients were more likely to have both control and disc negative than being a true positive (odds ratio = 6.2, 95% confidence interval = 2.5-14.6). Propionibacterium acnes was the most commonly identified bacteria. Two patients with disc positive cultures returned to the operating room secondary to pseudarthrosis; however, age, body mass index, prior spine surgery or injection, postoperative infection, and reoperations were not associated with culture results. Conclusion: In our cohort, the prevalence of subclinical bacterial infection in patients undergoing ACDF was 17.7%. While our rates exclude patients with positive contaminant control, the possibility of contamination of disc cultures could not be entirely rejected. Overall, culture results did not have any influence on postoperative outcomes.

Evidence for infection in intervertebral disc degeneration: a systematic review

“…C. acnes accounted for 77% cases of bacterial growth and researchers went on to investigate C. acnes sensitivity to antibiotics [ 33 ]. Recently, 96 cervical degeneration patients were recruited and 55% of all disc samples grew positive cultures [ 34 ]. Disc samples with a corresponding bacterial positive muscle biopsy were eliminated from analysis, leaving 17/96 (18%) of participants with a positive disc sample and a ‘clean’ control sample.…”

“…Predominantly C. acnes along with CoNS, Staphylococcus spp ., Streptococcus spp . and one example of Kocuria rhizophila was cultured in disc specimens [ 34 ].…”

“…Eight studies identified patient subgroups other than those with MC or herniation as susceptible to occult infection. Two studies reported greater bacterial growth in men than women [ 28 , 41 ] while one reported higher rates of infection in disc samples from women [ 34 ]. Two research groups reported higher rates of disc infection in younger participants [ 28 , 29 , 38 , 49 ], Yet Najafi and co-workers (2020) found specimens from older patients with MC were more likely to be C. acnes positive [ 40 ].…”

Degenerative Cervical Myelopathy: Insights into Its Pathobiology and Molecular Mechanisms

“…One of the emerging risk factors for DCM that has been coming to the fore recently is bacterial infection. Low virulence bacterial infections have been observed in degenerate cervical discs of DCM patients undergoing surgery; however, it is not yet clear if these infections play a role in the development of clinical symptoms [ 94 , 95 ]. Propionibacterium acnes and coagulase-negative Staphylococci were the most commonly identified bacteria.…”

Sheep as a Potential Model of Intradiscal Infection by the Bacterium Cutibacterium acnes

“…Over the last 20 years, evidence has accumulated to suggest that infection of IVDs especially with the anaerobic bacterium Cutibacterium acnes (previously Propionibacterium acnes ) may have an important role to play in the development of DDD and discogenic pain [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. This organism, which is a substantial component of the normal microbiota on human skin, is a low-grade opportunistic pathogen most famously described for its association with the inflammatory skin condition acne vulgaris [ 15 ].…”