Low virulence bacterial infections in cervical intervertebral discs: a prospective case series
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A prospective cross-sectional case series study.
To investigate the prevalence of low virulence disc infection and its associations with characteristics of patients or discs in the cervical spine.
Low virulence bacterial infections could be a possible cause of intervertebral disc degeneration and/or back pain. Controversies are continuing over whether these bacteria, predominantly Propionibacterium acnes (P. acnes), represent infection or contamination. However, the current studies mainly focus on the lumbar spine, with very limited data on the cervical spine.
Thirty-two patients (20 men and 12 women) who underwent anterior cervical fusion for degenerative cervical spondylosis or traumatic cervical cord injury were enrolled. Radiological assessments included X-ray, CT, and MRI of the cervical spine. Endplate Modic changes, intervertebral range of motion, and disc herniation type were evaluated. Disc and muscle tissues were collected under strict sterile conditions. Samples were enriched in tryptone soy broth and subcultured under anaerobic conditions, followed by identification of the resulting colonies by the PCR method.
Sixty-six intervertebral discs were excised from thirty-two patients. Positive disc cultures were noted in eight patients (25%) and in nine discs (13.6%). The muscle biopsy (control) cultures were negative in 28 patients and positive in 4 patients (12.5%); three of whom had a negative disc culture. Seven discs (10.6%) were positive for coagulase-negative Staphylococci (CNS) and two discs were positive for P. acnes (3.0%). A younger patient age and the extrusion or sequestration type of disc herniation, which represented a complete annulus fibrous failure, were associated with positive disc culture.
Our data show that CNS is more prevalent than P. acnes in degenerative cervical discs. The infection route in cervical discs may be predominantly through an annulus fissure. Correlation between these infections and clinical symptoms is uncertain; therefore, their clinical significance needs to be investigated in the future.
KeywordsDisc degeneration Disc infections Cervical spine Staphylococcus Propionibacterium
The authors would like to acknowledge Prof. Michael Adams for the assistance in revising this manuscript.
Funding and grants
Medical and health research project of Zhejiang Province (2015KYB448).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
Written informed consent was obtained from all participants in the study.
- 4.Capoor MN, Ruzicka F, Machackova T, Jancalek R, Smrcka M, Schmitz JE, Hermanova M, Sana J, Michu E, Baird JC, Ahmed FS, Maca K, Lipina R, Alamin TF, Coscia MF, Stonemetz JL, Witham T, Ehrlich GD, Gokaslan ZL, Mavrommatis K, Birkenmaier C, Fischetti VA, Slaby O (2016) Prevalence of Propionibacterium acnes in intervertebral discs of patients undergoing lumbar microdiscectomy: a prospective cross-sectional study. PLoS One 11(8):e0161676CrossRefPubMedGoogle Scholar
- 6.Rajasekaran S, Tangavel C, Aiyer SN, Nayagam SM, Raveendran M, Demonte NL, Subbaiah P, Kanna R, Shetty AP, Dharmalingam K (2017) ISSLS PRIZE IN CLINICAL SCIENCE 2017: is infection the possible initiator of disc disease? An insight from proteomic analysis. Eur Spine J 26(5):1384–1400CrossRefPubMedGoogle Scholar
- 13.Capoor MN, Ruzicka F, Schmitz JE, James GA, Machackova T, Jancalek R, Smrcka M, Lipina R, Ahmed FS, Alamin TF, Anand N, Baird JC, Bhatia N, Demir-Deviren S, Eastlack RK, Fisher S, Garfin SR, Gogia JS, Gokaslan ZL, Kuo CC, Lee Y-P, Mavrommatis K, Michu E, Noskova H, Raz A, Sana J, Shamie AN, Stewart PS, Stonemetz JL, Wang JC, Witham TF, Coscia MF, Birkenmaier C, Fischetti VA, Slaby O (2017) Propionibacterium acnes biofilm is present in intervertebral discs of patients undergoing microdiscectomy. PLoS One 12(4):e0174518CrossRefPubMedGoogle Scholar
- 16.Albert HB, Lambert P, Rollason J, Sorensen JS, Worthington T, Pedersen MB, Norgaard HS, Vernallis A, Busch F, Manniche C, Elliott T (2013) Does nuclear tissue infected with bacteria following disc herniations lead to Modic changes in the adjacent vertebrae? Eur Spine J 22(4):690–696CrossRefPubMedGoogle Scholar
- 23.Kowalski TJ, Berbari EF, Huddleston PM, Steckelberg JM, Osmon DR (2007) Propionibacterium acnes vertebral osteomyelitis: seek and ye shall find? Clin Orthop Relat Res 461:25–30Google Scholar
- 35.Kelsey JL (1978) Epidemiology of radiculopathies. Adv Neurol 19:385–398Google Scholar