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J Spinal Disord Tech. 2012 Oct;25(7):E211-6.

Bacteriology of degenerated lumbar intervertebral disks.

Author information

1
Department of Spine Surgery, University Hospital of Strasbourg, 1 Place de l’Hôpital, Strasbourg, France. joseph.arndt@chru-strasbourg.fr

Abstract

STUDY DESIGN:

A prospective microbiological analysis of intervertebral disk material in surgically treated patients presenting lumbar disk degeneration.

OBJECTIVE:

To determine the prevalence and species of bacteria in degenerated lumbar disks, their eventual role in the pathophysiology, and the possible influence of risk factors.

SUMMARY OF BACKGROUND DATA:

Intervertebral disk degeneration results from biochemical, mechanical, genetic, and toxic factors. The hypothesis of low-grade infection has been raised but not elucidated to date.

METHODS:

Eighty-three patients (34 males, 49 females, 41 y) were treated by lumbar disk replacement at L3-L4, L4-L5, or L5-S1. An intraoperative biopsy and microbiological culture were performed for each disk to determine if intradiskal bacteria were present. Magnetic resonance stages were Pfirrmann IV or V, with Modic I in 32, and Modic II in 25 cases. A preoperative discography was performed in 49 patients, 24 had previous nucleotomy.

RESULTS:

Bacteria were found in 40 disks, 43 cultures were sterile. The following bacteria were evidenced: Propionibacterium acnes 18, coagulase-negative staphylococci 16, gram-negative bacilli 3, Micrococcus 3, Corynebacterium 3, others 5. Ten biopsies presented 2 different species. Multinucleated cells were evidenced histologically in 33% of positive biopsies. Bacteria were predominantly found in males (P=0.012). The mostly positive level was L4-L5 (P=0.075). There was no significant relationship between bacterial evidence and Modic sign. A preoperative discography or previous nucleotomy did not represent significant contamination sources. None of the patients presented infectious symptoms.

CONCLUSIONS:

Although the hypothesis of biopsy contamination cannot be excluded, intradiskal bacteria might play a role in the pathophysiology of disk degeneration. However, the histologic presence of multinucleated cells may indicate an inflammatory process that could sustain the hypothesis of low-grade spondylodiscitis at 1 stage of the cascade of lumbar disk degeneration. These microbiological and histologic findings would need to be compared with nondegenerated disks.

LEVEL OF EVIDENCE:

: Diagnostic level III.

PMID:
22832554
DOI:
10.1097/BSD.0b013e318269851a
[Indexed for MEDLINE]

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