Related Experiment Video
Updated: Mar 26, 2026
Clinical Application of Microscope-Assisted Minimally Invasive Anterior Lumbar Interbody Fusion
Published on: June 16, 2023
Prospective study using anterior approach did not show association between Modic 1 changes and low grade infection in
Julien Rigal1, Thomas Thelen1, Fergus Byrne1
1Orthorachis 2, Orthopaedic Department, University of Bordeaux, Talence, France.
Introduction:
The modern literature is producing a rapidly growing number of articles which highlight the relationship between infection and lumbar disc degeneration. However, the means by which samples are collected is questionable. Posterior approach surgery is not free from skin contamination. The possibility of intraoperative contamination of disc biopsies cannot be excluded.
Objective:
The objective of this study was to determine if an association existed between lumbar disc degeneration and chronic infection of the intervertebral disc.
Materials And Methods:
313 patients (186/127, F/M) with chronic low back pain secondary to degenerative disc disease which was resistant to medical treatment were included in a single-centre prospective study. All underwent a lumbar anterior video-assisted minimally invasive fusion or disc prosthesis in L4-L5 and/or L5-S1 via an anterior retroperitoneal approach. The patients MRI scans demonstrated in Pfirrmann's classification grade IV or V disc degeneration; 385 disc drives were taken. In terms of Modic changes, 303 Modic 1, 58 Modic II and 24 absence of Modic change, respectively. All underwent intraoperative biopsy, performed according to a strict aseptic protocol. The biopsies were then cultured for 4 weeks with specialised enrichment cultures and subjected to histopathological analysis.
Results:
The mean age was 47 ± 8.6 years sterile cultures were obtained in 379 samples (98.4%) and 6 were positive (1.6%). The cultured bacteria were: Propionibacterium acnes (n:2), Staphylococcus epidermidis (n:2), Citrobacter freundii (n:1), and Saccharopolyspora hirsuta (n:1). Histopathological analysis did not demonstrate any evidence of a neutrophilia. There were no delayed or secondary infections.
Discussion And Conclusion:
Unlike the posterior approach where contamination is common, the anterior video-assisted approach allows a biopsy without skin contact. This approach to the spine is the most effective way to eliminate the risk of contamination. Our results confirm the absence of any relationship between infection and disc degeneration. We suggest that the 6 positive samples in our study may be related to contamination. The absence of infection at 1-year followup is an additional argument in favour of our results. In conclusion, our study shows no association between infection and disc degeneration. The pathophysiology of disc degeneration is complex, but the current literature opens new perspectives.
Insights
This study found no link between chronic infection and lumbar disc degeneration. An anterior surgical approach minimized contamination risk, suggesting previous positive cultures may have been due to contamination.
Area of Science:
- Spine Surgery
- Infectious Diseases
- Orthopedics
Background:
- Growing literature suggests a link between infection and lumbar disc degeneration.
- Concerns exist regarding sample contamination during posterior surgical approaches for disc biopsies.
- The potential for intraoperative contamination of intervertebral disc biopsies remains a significant concern.
Purpose of the Study:
- To investigate the association between chronic intervertebral disc infection and lumbar disc degeneration.
- To evaluate the efficacy of an anterior video-assisted minimally invasive approach in preventing sample contamination.
Main Methods:
- A prospective study included 313 patients with medically resistant degenerative disc disease (Pfirrmann grade IV-V).
- Anterior retroperitoneal approach for lumbar fusion or disc prosthesis at L4-L5/L5-S1.
- Intraoperative disc biopsies were collected under strict aseptic conditions and cultured for 4 weeks.
Main Results:
- Only 1.6% of biopsies yielded positive bacterial cultures (Propionibacterium acnes, Staphylococcus epidermidis, Citrobacter freundii, Saccharopolyspora hirsuta).
- Histopathological analysis showed no evidence of neutrophilia.
- No delayed or secondary infections were observed post-operatively.
Conclusions:
- The anterior video-assisted approach effectively minimizes contamination risk during disc biopsy.
- Results indicate no association between chronic infection and lumbar disc degeneration.
- Positive cultures are likely attributable to contamination, and the absence of infection at 1-year follow-up supports these findings.
