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Bacteria: back pain, leg pain and Modic sign—a surgical multicentre comparative study
Futurum Academy, Länssjukhuset Ryhov, Jönköping, Sweden.
Sahlgrenska University Hospital, Göteborg, Sweden.
Sahlgrenska University Hospital, Göteborg, Sweden.
Uppsala University Hospital, Uppsala, Sweden.
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2019 (English)In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 28, no 12, p. 2981-2989Article in journal (Refereed) Published
Abstract [en]

Purpose: To compare bacterial findings in pain-generating degenerated discs in adults operated on for lumbar disc herniation (LDH), and mostly also suffering from low back pain (LBP), with findings in adolescent patients with non-degenerated non-pain-generating discs operated on for scoliosis, and to evaluate associations with Modic signs on magnetic resonance imaging (MRI). Cutibacterium acnes (Propionibacterium acnes) has been found in painful degenerated discs, why it has been suggested treating patients with LDH/LBP with antibiotics. As multidrug-resistant bacteria are a worldwide concern, new indications for using antibiotics should be based on solid scientific evidence.

Methods: Between 2015 and 2017, 40 adults with LDH/LBP (median age 43, IQR 33–49) and 20 control patients with scoliosis (median age 17, IQR 15–20) underwent surgery at seven Swedish hospitals. Samples were cultured from skin, surgical wound, discs and vertebrae. Genetic relatedness of C. acnes isolates was investigated using single-nucleotide polymorphism analysis. DNA samples collected from discs/vertebrae were analysed using 16S rRNA-based PCR sequencing. MRI findings were assessed for Modic changes.

Results: No bacterial growth was found in 6/40 (15%) LDH patients, compared with 3/20 (15%) scoliosis patients. Most positive samples in both groups were isolated from the skin and then from subcutis or deep within the wound. Of the four disc and vertebral samples from each of the 60 patients, 235/240 (98%) were DNA negative by bacterial PCR. A single species, C. acnes, was found exclusively in the disc/vertebra from one patient in each group. In the LDH group, 29/40 (72%) patients had at least one sample with growth of C. acnes, compared to 14/20 (70%) in the scoliosis group. Bacterial findings and Modic changes were not associated.

Conclusions: Cutibacterium acnes found in discs and vertebrae during surgery for disc herniation in adults with degenerated discs may be caused by contamination, as findings in this group were similar to findings in a control group of young patients with scoliosis and non-degenerated discs. Furthermore, such findings were almost always combined with bacterial findings on the skin and/or in the wound. There was no association between preoperative Modic changes and bacterial findings. Antibiotic treatment of lumbar disc herniation with sciatica and/or low back pain, without signs of clinical discitis/spondylitis, should be seriously questioned. 

Place, publisher, year, edition, pages
Springer, 2019. Vol. 28, no 12, p. 2981-2989
Keywords [en]
Culturing, Cutibacterium acnes, DNA analyses, Low back pain, Lumbar disc herniation, Magnetic resonance imaging (MRI), Multicentre clinical study, RNA 16S, adult, Article, bacterial growth, bacterium isolation, clinical article, comparative study, female, human, lumbar disk hernia, male, modic sign, multicenter study, nuclear magnetic resonance imaging, observational study, polymerase chain reaction, priority journal, Propionibacterium acnes, prospective study, scoliosis, single nucleotide polymorphism, skin culture, surgical wound, symptomatology
National Category
Orthopaedics
Identifiers
URN: urn:nbn:se:hj:diva-47451DOI: 10.1007/s00586-019-06164-1ISI: 000496831100003PubMedID: 31576463Scopus ID: 2-s2.0-85074150860Local ID: HOA HHJ 2019OAI: oai:DiVA.org:hj-47451DiVA, id: diva2:1386932
Funder
Medical Research Council of Southeast Sweden (FORSS)Available from: 2020-01-20 Created: 2020-01-20 Last updated: 2020-01-20Bibliographically approved

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