Human intervertebral discs harbour a unique microbiome and dysbiosis determines health and disease



To document the role of sub-clinical infections in disc disorders and investigate the existence of microbiome in intervertebral discs (IVD).


Genomic DNA from 24 lumbar IVDs [8—MRI normal discs (ND) from brain dead yet alive organ donors, 8—disc herniation (DH), 8—disc degeneration (DD)] was subjected to 16SrRNA sequencing for profiling the diversity of human disc microbiome in health and disease. The disc microbiome was further compared to established human gut and skin microbiomes.


All healthy MRI normal discs from brain dead yet alive organ donors also had a rich bacterial presence. A total of 424 different species (355-ND, 346-DD, and 322-DH) were detected, with 42.75% OTUs being classified at kingdom level, 44% at the phylum level, 22.62% at genus level, and 5.5% at species level. Varying biodiversity and abundance between healthy and diseased discs were documented with protective bacteria being abundant in normal discs, and putative pathogens abundant in DD and DH. Propionibacterium acnes had a similar but lower abundance to other pathogens in all three groups ND (3.07%), DD (3.88%), DH (1.56%). Fifty-eight bacteria were common between gut and IVD microbiomes, 29 between skin and IVD microbiomes, and six common to gut/skin/IVD.


Our study challenges the hitherto concept of sterility in healthy IVD and documented a microbiome even in MRI normal healthy discs. The varying abundance of bacteria between ND, DD, and DH documents ‘dysbiosis’ as a possible etiology of DD. Many known pathogens were identified in greater abundance than Propionibacterium acnes, and there was evidence for the presence of the gut/skin/spine microbiome axis.

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16S rRNA:

16 (Svedberg) ribosomal ribonucleic acid


Ribosomal subunit contains 16S rRNA


Ribosomal subunit


Data analysis decision and action


Disc degeneration


Disc herniation


Deoxyribose nucleic acid


Electrospray ionization


Green GENES database version 138


Intuitional Review Board


Low back pain


Liquid chromatography


Software search engine to identify proteins uses MOWSE algorithm


Magnetic resonance imaging


Tandem mass spectrometry

MW test:

Mann–Whitney test


Normal disc


Operational taxonomic unit


Phylogenetic investigation of communities by reconstruction of unobserved states




Quantitative insights into microbial ecology

R packages:

Statistical tool designed by Ross Ihaka and Robert gentleman

Sequest HT:

Tandem mass spectrometric data analysis program used for protein identification


Statistical analysis of taxonomic and functional profiles


Testing hypotheses on the mean of the normal distribution


Nine hypervariable regions


Transplant authority government of Tamil Nadu, India


Hydrochloric acid


Sodium chloride


Revolutions per minute


Sodium dodecyl sulphate polyacrylamide gel electrophoresis




Statistical package for the social sciences


Parts per million


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The corresponding author has full access to the data analysed in this study and holds all responsibilities towards the submission of this article. We acknowledge the receipt of grants from the Ganga Orthopaedic Research & Education Foundation (GOREF 2018-08) and AO Spine (AOSIN(R) 2017-04). All authors contributed equally to the preparation of this manuscript. We acknowledge the efforts taken by all the authors equally in preparing this manuscript and also thank GOREF for funding the project.


The project was mainly funded by Ganga Orthopaedic Research & Education Foundation (GOREF 2018-08) and partially by the AO Spine (AOSIN(R) 2017-04).

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Correspondence to Shanmuganathan Rajasekaran.

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The study was performed only after approval of the IRB committee.

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Rajasekaran, S., Soundararajan, D.C.R., Tangavel, C. et al. Human intervertebral discs harbour a unique microbiome and dysbiosis determines health and disease. Eur Spine J 29, 1621–1640 (2020).

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  • Disc degeneration
  • Sub-clinical infection
  • Microbiome
  • Dysbiosis
  • Inflammaging