Overview: the role of Propionibacterium acnes in nonpyogenic intervertebral discs

Abstract

Propionibacterium acnes (P. acnes), an important opportunistic anaerobic Gram-positive bacterium, causes bone and joint infections, discitis and spondylodiscitis. Accumulated evidence suggested that this microbe can colonise inside intervertebral discs without causing symptoms of discitis. Epidemiological investigation shows that the prevalence ranges from 13 % to 44 %. Furthermore, colonisation by P. acnes inside nonpyogenic intervertebral discs is thought to be one pathogen causing sciatica, Modic changes and nonspecific low back pain. Specially, patients can attain significant relief of low back pain, amelioration of Modic changes and alleviation of sciatica after antibiotic therapy, indicating the role of P. acnes in these pathological changes. However, until now, there were hypotheses only to explain problems such as how P. acnes access intervertebral discs and what the exact pathological mechanism it employs during its latent infection period. In addition, research regarding diagnostic procedures and treatment strategies were also rare. Overall, the prevalence and possible pathological role that P. acnes plays inside nonpyogenic intervertebral discs is summarised in this paper.

Pharmacotherapy of chronic back pain: Are there prospects?

“…В итоге инфекци-онная теория возникновения ХБС не получила дальнейше-го развития, хотя и вызывает несомненный интерес многих исследователей [72,73].…”

10 Years of Research: From Ignoring Modic Changes to Considerations Regarding Treatment and Prevention of Low-Grade Disc Infections

“…The degenerative and the infectious pathways may work concurrently and together accelerate the destruction of the spinal segment structures [9,11]. …”

“…The infectious pathway takes place as a result of a series of occurrences in and around the disc and end plates as is the case for the degenerative/mechanical pathway. The latest research in this field appears to confirm the existence of an infectious pathway: Low virulent bacteria enter the disc following a herniation or small trauma related annular tears [11,14]. This process may well be facilitated by the tearing of end plate fragments often seen in biopsies of herniated material that render the end plate damaged, which also delays herniated disc material resorption and results in neovascularization [15–18];…”

“…The latest research in this field appears to confirm the existence of an infectious pathway:

Low virulent bacteria enter the disc following a herniation or small trauma related annular tears [11,14]. This process may well be facilitated by the tearing of end plate fragments often seen in biopsies of herniated material that render the end plate damaged, which also delays herniated disc material resorption and results in neovascularization [15–18];

The bacteria are randomly transported through the circulatory system to the discs or may enter from contamination in spinal-related surgical procedures [4,11,18];When the skin barrier is broken, there is a risk of bacterial spreading from the folds of the skin and sebaceous glands to spine despite sterilization procedures [19]. In some cases, the invading bacteria may have a nonskin origination, for example, from the oral cavity, as shown by Rollason et al .…”

Propionibacterium acnes Induces Intervertebral Disc Degeneration by Promoting iNOS/NO and COX‐2/PGE2 Activation via the ROS‐Dependent NF‐κB Pathway

“…However, recent studies suggest that Propionibacterium acnes ( P. acnes )—a low-virulence anaerobic bacterium found to reside latently within nonpyogenic intervertebral discs (IVDs)—can induce IVDD [2]. In patients with IVDD, the prevalence of P. acnes has ranged from 13% to 44% [3–7].…”