Association between sciatica and microbial infection: true infection or culture contamination?

Area of Science:

• Orthopedics
• Microbiology
• Neurosurgery

Background:

• Sciatica is often associated with disc herniation and radiculopathy.
• Previous studies have reported bacterial cultures from intervertebral discs in sciatica patients.
• An infectious etiology for sciatica could significantly alter treatment strategies.

Purpose of the Study:

• To investigate the role of bacteria in the inflammatory process of disc herniation and radiculopathy.
• To determine if microbial infection is culpable in the pathogenesis of sciatica.

Main Methods:

• Intervertebral disc specimens were obtained during discectomy from patients with diagnosed disc herniation, back pain, and radiculopathy.
• Stringent intraoperative sterile techniques were employed to minimize contamination risk during specimen processing and culturing.
• Specimens were divided and cultured in various aerobic and anaerobic media for two weeks.

Main Results:

• Out of 120 specimens from 30 patients, 116 cultures were sterile.
• Bacterial growth (coagulase-negative staphylococci) was observed in only 4 aerobic cultures, involving 2 patients, and was deemed suggestive of contamination.
• The vast majority of cultures remained negative, even with meticulous aseptic procedures.

Conclusions:

• The findings refute the hypothesis that microbial infection is a primary cause of sciatica.
• Previous reports of bacterial growth in disc herniation may be attributed, in part, to contamination.
• Rigorous aseptic techniques are crucial for accurately assessing the role of infection in disc pathology.