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Relationship between annular tear and presence of Propionibacterium acnes in lumbar intervertebral disc
Zezhu Zhou1,2, Zhe Chen1,2, Yuehuan Zheng3
1Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, People's Republic of China.
Purpose:
Propionibacterium acnes (P. acnes) in the intervertebral disc may result in low back pain. The purpose of this study was to determine how P. acnes accesses the disc.
Methods:
Patients with low back pain and/or sciatica were examined using X-ray and MRI before surgery. The intervertebral disc space height was measured on X-ray image. Disc and muscle samples were obtained from 46 patients undergoing discectomy at the lumbar spine. The tear of annulus was inspected before discectomy. In the disc and muscle tissue cultures, 16S rDNA gene specific for P. acnes was examined using PCR.
Results:
The discs from 11 (23.9 %) patients were identified as 16S rDNA positive, in which two patients also had 16S rDNA in their muscles. 16S rDNA gene was significantly more likely to appear in the discs with annular tear than those without tear (P < 0.05). The disc space height was significantly decreased when the disc contained P. acnes.
Conclusion:
P. acnes is significantly more likely to be present in herniated discs with an annular tear than in herniated discs without such a tear. Since in the vast majority of these cases, no P. acnes was found in control muscle samples, a true infection with P. acnes is far more likely than a contamination.
Insights
Propionibacterium acnes (P. acnes) may cause low back pain by entering the intervertebral disc through annular tears. Its presence is linked to decreased disc height, suggesting infection rather than contamination.
Area of Science:
- Spinal surgery
- Microbiology
- Orthopedics
Background:
- Propionibacterium acnes (P. acnes) is implicated in low back pain.
- The mechanism of P. acnes accessing the intervertebral disc is unclear.
Purpose of the Study:
- To investigate how P. acnes accesses the intervertebral disc.
- To determine the association between P. acnes and disc pathology.
Main Methods:
- X-ray and MRI were used to assess patients with low back pain.
- Disc and muscle samples from 46 patients undergoing discectomy were cultured.
- Polymerase chain reaction (PCR) was used to detect P. acnes 16S rDNA.
Main Results:
- P. acnes DNA was detected in 23.9% of disc samples.
- P. acnes was significantly more prevalent in discs with annular tears (P < 0.05).
- Disc height was significantly reduced in P. acnes-positive discs.
Conclusions:
- P. acnes is frequently found in herniated discs with annular tears.
- The absence of P. acnes in surrounding muscle suggests true infection over contamination.
- Annular tears appear to be a key route for P. acnes disc invasion.
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