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- Title
The Infectious Etiology of Degenerative Disc Disease: Myth or Reality?
- Authors
Jarzem, Peter; Aoude, Ahmed; Raasck, Kyle; Weber, Michael; Almajed, Husam; Wang, Patrick; Ouellet, Jean
- Abstract
Introduction: Lower back pain (LBP) is the world's leading cause of disability, with over 632 million people affected worldwide. A major etiological factor contributing to LBP is the progressive degeneration of intervertebral discs (IVD), which leads to disc herniation. It has been postulated that this nutrient rich anaerobic environment makes the disc susceptible to opportunistic bacteria. A recent double blind randomized study demonstrated that antibacterial treatments significantly reduced lower back pain, but the relationship between bacterial infection and disc degeneration remains largely unexplored. The objective of this study is to determine if degenerative disc disease is associated with colonization of the disc with low virulence micro-organisms. Material and Methods: Disc cultures were carried out systematically in all of one surgeon's patients undergoing spine surgery for degenerative disc disease at our institution. All patients with disc cultures sent to microbiology laboratories were analyzed and the species of micro-organism was documented. All patients included in the study provided consent for tissue donation for research. Patients without disc specimens, without cultures or with a known discitis were excluded. Results: We identified 61 patients undergoing undergoing spine surgery for degenerative disc disease, excluding known discitis or history of infections, between December 2015 and July 2016. The average patient age was 59 years and a total of 88 disc cultures were analyzed. In total, 12 patients (20%) had positive disc cultures, with 100% of patients undergoing revision fusions growing bacteria from the disc space (p < 0.05). Subgroup analysis indicated that disc hernias had the highest positive culture rate among all other etiologies, with 29% (p < 0.05) growing bacteria. Staphylococcus epidermidis was the most common organism (33%), though Propionibacterium acnes, Clostridium, Corynebacterium, Escherichia coli, Streptococcus and Staphylococcus species were also found to be present. Conclusion: This is the first study to sample intervertebral discs from a cohort of patients considered to have primary degenerative conditions of the spine. Our study demonstrates that degenerate discs are frequently co-infected with bacterial species. The highest infection rates were in disc hernias (29%) and revision fusions (100%). These preliminary data support the notion that bacterial infection may be a source of back pain in patients with degenerative discs, as there may be an infectious etiology in significant proportion (20%). Furthermore, the use of prophylactic antibiotics in revision fusions should be explored. Given the current surgical treatment for LBP is lumbar fusion - an invasive procedure which carries significant cost and risk - determining the microbiological validity of antibacterial use for lower back pain is of paramount importance. These results warrant further investigation, and a larger study is ongoing.
- Publication
Global Spine Journal, 2018, Vol 8, p48S
- ISSN
2192-5682
- Publication type
Academic Journal
- DOI
10.1177/2192568218771030