Relationship between annular tear and presence of Propionibacterium acnes in lumbar intervertebral disc

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

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“…The growing body of evidence suggests that bacterial contamination cannot explain all of the reported cases 30 . Fritzell et al 31 .…”

Section: Discussionmentioning

confidence: 99%

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

Coscia

Denys

Wack

2016

Spine

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“…However, it is not clear what the underlying mechanisms used by P. acnes are to induce infection, inflammation and/or metastasis outside the skin. What is known with some certainty is that bacteria-infected keratinocytes, sebocytes and/or adipocytes secrete several pro-inflammatory chemokines and cytokines as well as anti-microbial factors (e.g., cathelicidin) hinting at specific disease mechanisms (Graham et al, 2004; Nagy et al, 2006; Lee et al, 2010; Zhou et al, 2015; Sanford et al, 2016; Yu et al, 2016). …”

Section: General Overviewmentioning

confidence: 99%

P. acnes-Driven Disease Pathology: Current Knowledge and Future Directions

Leheste

Ruvolo

Chrostowski

et al. 2017

Front. Cell. Infect. Microbiol.

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This review discusses the biology and behavior of Propionibacterium acnes (P. acnes), a dominant bacterium species of the skin biogeography thought to be associated with transmission, recurrence and severity of disease. More specifically, we discuss the ability of P. acnes to invade and persist in epithelial cells and circulating macrophages to subsequently induce bouts of sarcoidosis, low-grade inflammation and metastatic cell growth in the prostate gland. Finally, we discuss the possibility of P. acnes infiltrating the brain parenchyma to indirectly contribute to pathogenic processes in neurodegenerative disorders such as those observed in Parkinson's disease (PD).

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“…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];…”

Section: The Infectious Pathway: the Scientific Casementioning

confidence: 99%

“…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];…”

Section: The Infectious Pathway: the Scientific Casementioning

confidence: 99%

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

Manniche

Jordan

2016

Future Sci. OA

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Relationship between annular tear and presence of Propionibacterium acnes in lumbar intervertebral disc

Cited by 51 publications

References 29 publications

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

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

P. acnes-Driven Disease Pathology: Current Knowledge and Future Directions

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

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