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Evidence for infection in intervertebral disc degeneration: a systematic review

PainSci » bibliography » Smith et al 2022
Tags: etiology, back pain, pro, pain problems, spine

PainSci notes on Smith 2022:

This is a good (but dense and technical) review of the low-grade infection as a possible causing back pain. The study was limited to patients who had undergone surgery, to shed light on the question of whether C. Acnes was introduced by the surgery (contamination), or was present in the disc before surgery. The C. acnes bacteria has definitely been found in degenerating intervertebral discs, and contamination can’t explain it—but “culturing bias” might. All this is worth more study, but so far there is “insufficient evidence exists to suggest changes to current clinical treatment.”

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

PURPOSE: Back pain is a major problem worldwide and is linked to intervertebral disc degeneration and Modic change. Several studies report growth of bacteria following extraction of degenerate discs at spine surgery. A pathophysiological role for infection in back pain has been proposed.

METHOD: We conducted a PRISMA systematic review. MEDLINE, PubMed, Scopus and Web of Science were searched with the terms Modic change, intervertebral dis*, bacteria, microb*, and infect*. Date limits of 2001-2021 were set. Human studies investigating the role of bacteria in disc degeneration or Modic change in vertebrae were included.

RESULTS: Thirty-six articles from 34 research investigations relating to bacteria in human degenerate discs were found. Cutibacterium acnes was identified in pathological disc material. A 'candidate bacterium' approach has been repeatedly adopted which may have biased results to find species a priori, with disc microbial evidence heavily weighted to find C. acnes.

CONCLUSION: Evidence to date implicates C. acnes identified through culture, microscopy and sequencing, with some suggestion of diverse bacterial colonisation in the disc. This review found studies which used culture methods and conventional PCR for bacterial detection. Further agnostic investigation using newer methods should be undertaken.

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