Does nuclear tissue infected with bacteria following disc herniations lead to Modic changes in the adjacent vertebrae?
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To investigate the prevalence of infected herniated nucleus material in lumbar disc herniations and to determine if patients with an anaerobic infected disc are more likely to develop Modic change (MC) (bone oedema) in the adjacent vertebrae after the disc herniation. MCs (bone oedema) in vertebrae are observed in 6 % of the general population and in 35–40 % of people with low back pain. These changes are strongly associated with low back pain. There are probably a mechanical cause and an infective cause that causes MC. Several studies on nuclear tissue from herniated discs have demonstrated the presence of low virulent anaerobic microorganisms, predominantly Propionibacterium acnes, in 7–53 % of patients. At the time of a herniation these low virulent anaerobic bacteria may enter the disc and give rise to an insidious infection. Local inflammation in the adjacent bone may be a secondary effect due to cytokine and propionic acid production.
Patients undergoing primary surgery at a single spinal level for lumbar disc herniation with an MRI-confirmed lumbar disc herniation, where the annular fibres were penetrated by visible nuclear tissue, had the nucleus material removed. Stringent antiseptic sterile protocols were followed.
Sixty-one patients were included, mean age 46.4 years (SD 9.7), 27 % female. All patients were immunocompetent. No patient had received a previous epidural steroid injection or undergone previous back surgery. In total, microbiological cultures were positive in 28 (46 %) patients. Anaerobic cultures were positive in 26 (43 %) patients, and of these 4 (7 %) had dual microbial infections, containing both one aerobic and one anaerobic culture. No tissue specimens had more than two types of bacteria identified. Two (3 %) cultures only had aerobic bacteria isolated.
In the discs with a nucleus with anaerobic bacteria, 80 % developed new MC in the vertebrae adjacent to the previous disc herniation. In contrast, none of those with aerobic bacteria and only 44 % of patients with negative cultures developed new MC. The association between an anaerobic culture and new MCs is highly statistically significant (P = 0.0038), with an odds ratio of 5.60 (95 % CI 1.51–21.95).
These findings support the theory that the occurrence of MCs Type 1 in the vertebrae adjacent to a previously herniated disc may be due to oedema surrounding an infected disc. The discs infected with anaerobic bacteria were more likely (P < 0.0038) to develop MCs in the adjacent vertebrae than those in which no bacteria were found or those in which aerobic bacteria were found.
- Jensen TS, Karppinen J, Sorensen JS, Niinimäki J, Leboeuf-Yde C (2008) Prevalence of vertebral endplate signal changes and their association with non-specific low back pain - A systematic literature review. Eur Spine J 17:1407–1422 CrossRef
- Albert HB, Manniche C (2007) Modic changes following lumbar disc herniation. Eur Spine 16:977–982 CrossRef
- Airaksinen O, Brox JI, Cedraschi C et al (2006) European Guidelines: COST B13 Working Group on Guidelines for Chronic Low Back Pain. Eur Spine J 15(Suppl 2):S192–S300 CrossRef
- Modic MT, Steinberg PM, Ross JS et al (1988) Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 166:193–199
- Wang Y, Videman T, Niemeläinen R, Battié MC (2011) Quantitative measures of modic changes in lumbar spine magnetic resonance imaging: intra- and inter-rater reliability. Spine 36:1236–1243 CrossRef
- Peterson CK, Gatterman B, Carter JC, Humphreys BK, Weibel A (2007) Inter- and intraexaminer reliability in identifying and classifying degenerative marrow (Modic) changes on lumbar spine magnetic resonance scans. J Manipulative Physiol Ther 30:85–90 CrossRef
- Jensen TS, Sorensen JS, Kjaer P (2007) Intra- and interobserver reproducibility of vertebral endplate signal (Modic) changes in the lumbar spine: the Nordic Modic Consensus Group classification. Acta Radiol 48:748–754 CrossRef
- Solgaard SJ, Kjaer P, Jensen ST, Andersen P (2006) Low-field magnetic resonance imaging of the lumbar spine: reliability of qualitative evaluation of disc and muscle parameters. Acta Radiol 47:947–953 CrossRef
- Albert HB, Kjaer P, Jensen TS, Sorensen JS, Bendix T, Manniche C (2008) Modic changes, possible causes and relation to low back pain. Med Hypotheses 70:361–368 CrossRef
- Stirling A, Worthington T, Rafiq M et al (2001) Association between sciatica and Propionebacterium acnes. Lancet 357:2024–2025 CrossRef
- Stirling AJ, Jiggins M (2002) Association between sciatica and skin commensals. International Society for the Study of the Lumbar Spine, Cleveland
- Bhanji S, Williams B, Sheller B, Elwood T, Mancl L (2002) Transient bacteremia induced by tooth brushing a comparison of the Sonicare toothbrush with a conventional toothbrush. Pediatr Dent 24:295–299
- Roberts GJ, Holzel HS, Sury MR (1997) Dental bacteremia in children. Pediatr Cardiol 18:24–27 CrossRef
- Farrar MD, Ingham E (2004) Acne: inflammation. Clin Dermatol 22:380–384 CrossRef
- Doita M, Kanatani T, Harada T, Mizuno K (1996) Immunohistologic study of the ruptured intervertebral disc of the lumbar spine. Spine 21:235–241 CrossRef
- Hirabayashi S, Kumano K, Tsuiki T, Eguchi M, Ikeda S (1990) A dorsally displaced free fragment of lumbar disc herniation and its interesting histologic findings. A case report. Spine 15:1231–1233
- Ito T, Yamada M, Ikuta F et al (1996) Histologic evidence of absorption of sequestrationtype herniated disc. Spine 21:230–234 CrossRef
- Lindblom K, Hultquist G (1950) Absorption of protruded disc tissue. J Bone Joint Surg 32-A:557–560
- Gronblad M, Virri J, Tolonen J et al (1994) A controlled immunohistochemical study of inflammatory cells in disc herniation tissue. Spine 19:2744–2751 CrossRef
- Albert HB, Manniche C (2007) Modic changes following lumbar disc herniation. Eur Spine J 16:977–982 CrossRef
- Lomholt HB, Kilian M (2008) Er acne vulgaris en infektion med den » forkerte « Propionibacterium acnes? Ugeskr Laeger 170:1234–1237 [Danish]
- Wedderkopp N, Thomsen K, Manniche C, Kolmos HJ, Secher Jensen T, Leboeuf Yde C C (2009) No evidence for presence of bacteria in modic type I changes. Acta Radiol 50:65–70 CrossRef
- Albert HB, Manniche C, Sorensen JS, Deleuran BW (2008) Antibiotic treatment in patients with low-back pain associated with Modic changes Type 1 (bone oedema): a pilot study. Br J Sports Med 42:969–973 (Epub 2008 Aug 21) CrossRef
- Sfanos KS, Isaacs WB (2008) An evaluation of PCR primer sets used for detection of Propionibacterium acnes in prostate tissue samples. Prostate 68:1492–1495 CrossRef
- Caddick JM, Hilton AC, Rollason J, Lambert PA, Worthington T, Elliott TS (2005) Molecular analysis of methicillin-resistant Staphylococcus aureus reveals an absence of plasmid DNA in multidrug-resistant isolates. FEMS Immunol Med Microbiol 44:297–302 CrossRef
- Nadkarni MA, Martin FE, Jacques NA, Hunter N (2002) Determination of bacterial load by real-time PCR using a broad-range (universal) probe and primers set. Microbiology 148:257–266
- Corsia MF, Wack M, Denys G. (2003).Low virulence Bacterial infections of intervertebral discs and the resultant spinal disease processes. Abstract from Scoliosis Research Society (SRS) annual meeting
- Agarwal VJ, Golish SR, Alamin TF (2011) Bacteriologic culture of excised intervertebral disc from immunocompetent patients undergoing single level primary lumbar microdiscectomy. J Spinal Disord Tech 24:397–400 CrossRef
- Fritzell P, Bergström T, Welinder-Olsson C (2004) Detection of bacterial DNA in painful degenerated spinal discs in patients without signs of clinical infection. Eur Spine J 13:702–706 CrossRef
- Ben-Galim P, Rand N, Giladi M, Schwartz D et al (2006) Ashkenazi E, Millgram M, Dekel S, Floman Y. Association between sciatica and microbial infection: true infection or culture contamination? Spine 31:2507–2509 CrossRef
- Van Goethem JW, Van de Kelft E, Biltjes IG et al (1996) MRI after successful lumbar discectomy. Neuroradiology. 38(Suppl 1):S90–S96
- Adams MA, McNally DS, Dolan P (1996) ‘Stress’ distributions inside intervertebral discs. The effects of age and degeneration. J Bone Jt Surg Br 78:965–972 CrossRef
- Adams MA, Freeman BJ, Morrison HP, Nelson IW, Dolan P (2000) Mechanical initiation of intervertebral discs degeneration. Spine 25:1625–1636 CrossRef
- Does nuclear tissue infected with bacteria following disc herniations lead to Modic changes in the adjacent vertebrae?
European Spine Journal
Volume 22, Issue 4 , pp 690-696
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Bacterial infection
- Modic changes
- Endplate changes
- Propionibacterium acnes
- Lumbar disc herniation
- Industry Sectors
- Author Affiliations
- 1. Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt, Middelfart, Institute of Regional Health Services Research, University of Southern Denmark, Clinical Locomotion Science Network, Ostre Houghvej 55, 5550, Middelfart, Denmark
- 2. The School of Life and Health Sciences at Aston University, Birmingham, UK
- 3. University Hospital NHS Trust, Birmingham, UK
- 4. The Mølholm Private Hospital, Vejle, Denmark