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Bacteria and Lumbar Back Pain - No Association with Degenerated Discs

24 Pages Posted: 24 Jan 2019

See all articles by Peter Fritzell

Peter Fritzell

Ryhov Hospital

Christina Welinder-Olsson

University of Gothenburg - Sahlgrenska University Hospital

Bodil Jönsson

University of Gothenburg - Sahlgrenska University Hospital

Åsa Melhus

Uppsala University - Uppsala University Hospital

Siv Andersson

Uppsala University

Tomas Bergström

University of Gothenburg - Sahlgrenska University Hospital

Hans Tropp

Linkoping University

Paul Gerdhem

Karolinska Institutet - Karolinska University Hospital

Olle Hägg

GHP Spine Center Göteborg

Hans Laestander

GHP Spine Center Göteborg

Björn Knutsson

Sundsvall Regional Hospital

Anders Lundin

Örebro University Hospital

Per Ekman

Södersjukhuset (Sös)

Eric Rydman

Södersjukhuset (Sös)

Mikael Skorpil

Karolinska Institutet - Karolinska University Hospital

More...

Abstract

Background: Low back pain (LBP) with or without lumbar disc herniation (LDH) is one of the most commonly found symptoms worldwide. The etiology is often unclear, but a low-grade infection caused by the anaerobic skin bacterium Cutibacterium acnes (formerly Propionibacterium acnes), sometimes found on culture during LDH surgery, has been suggested as a cause. Given worldwide concern over multidrug resistant bacteria, further investigation is highly warranted. Our study aimed to compare findings regarding bacterial presence in painful lumbar degenerative disc disease (DDD) in adults having LDH with findings in young patients with scoliosis, but without DDD or relevant lumbar pain.  

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

Findings: No bacterial growth was found in 6/40 (15%) LDH patients, compared with 3/20 (15%) scoliosis patients. 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, while the corresponding figure in the scoliosis group was 14/20 (70%). There was no association between bacterial findings and Modic changes.    

Interpretations: The results suggest that finding bacteria like C. acnes in discs and vertebrae during surgery is likely due to contamination. Antibiotic use to treat LBP/LDH without signs of clinical discitis/spondylitis should be seriously questioned.  

Funding Statement:  The study was funded by FORSS, a Swedish regional research foundation  

Declaration of Interests: The authors state: " no conflicts of interest to declare."

Ethics Approval Statement: The study was approved by the ethical committee in Linköping (EPN, Ref. no. 2015/152-31). All patients gave their written informed consent.

Keywords: Lumbar disc herniation; Lumbar pain, Degenerative Disc Disease; Cutibacterium acnes; Infection; Contamination

Suggested Citation

Fritzell, Peter and Welinder-Olsson, Christina and Jönsson, Bodil and Melhus, Åsa and Andersson, Siv and Bergström, Tomas and Tropp, Hans and Gerdhem, Paul and Hägg, Olle and Laestander, Hans and Knutsson, Björn and Lundin, Anders and Ekman, Per and Rydman, Eric and Skorpil, Mikael, Bacteria and Lumbar Back Pain - No Association with Degenerated Discs (January 17, 2019). Available at SSRN: https://ssrn.com/abstract=3320143 or http://dx.doi.org/10.2139/ssrn.3320143

Peter Fritzell (Contact Author)

Ryhov Hospital ( email )

Jönköping
Sweden

Christina Welinder-Olsson

University of Gothenburg - Sahlgrenska University Hospital

PO Box 400
Göteborg, SE405 30
Sweden

Bodil Jönsson

University of Gothenburg - Sahlgrenska University Hospital

PO Box 400
Göteborg, SE405 30
Sweden

Åsa Melhus

Uppsala University - Uppsala University Hospital

Sweden

Siv Andersson

Uppsala University

Box 513
Uppsala, 751 20
Sweden

Tomas Bergström

University of Gothenburg - Sahlgrenska University Hospital

PO Box 400
Göteborg, SE405 30
Sweden

Hans Tropp

Linkoping University

Överstegatan 30
Linkoping, 581 83
Sweden

Paul Gerdhem

Karolinska Institutet - Karolinska University Hospital

Solna, 17176
Sweden

Olle Hägg

GHP Spine Center Göteborg

Sweden

Hans Laestander

GHP Spine Center Göteborg

Sweden

Björn Knutsson

Sundsvall Regional Hospital

Sweden

Anders Lundin

Örebro University Hospital

Sweden

Per Ekman

Södersjukhuset (Sös)

Sweden

Eric Rydman

Södersjukhuset (Sös)

Sweden

Mikael Skorpil

Karolinska Institutet - Karolinska University Hospital

Solna, 17176
Sweden

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