Ribosomal PCR assay of excised intervertebral discs from patients undergoing single-level primary lumbar...

Area of Science:

• Orthopedics
• Microbiology
• Neurosurgery

Background:

• Previous studies suggested a significant rate of low-virulent organisms in herniated disc samples.
• These findings formed the basis for trials investigating antibiotic treatment for chronic low back pain.
• The validity of positive cultures in discectomy specimens remains unproven and critical for understanding treatment efficacy.

Purpose of the Study:

• To determine the presence of infectious microorganisms in herniated discs of immunocompetent patients.
• To employ highly sensitive and specific methodologies for microorganism detection.
• To clarify the role of bacterial infection in chronic low back pain.

Main Methods:

• A consecutive case series of 44 immunocompetent patients undergoing lumbar microdiscectomy for radiculopathy.
• Analysis of excised disc material using real-time PCR targeting the 16S ribosomal RNA gene, followed by amplicon sequencing.
• Exclusion of patients with immune compromise and concurrent cultures.

Main Results:

• The PCR assay for the 16S rRNA sequence was negative in all 44 patients (100%).
• The 95% confidence interval for positive results was 0-8%.
• No evidence of bacterial infection was detected in the analyzed disc samples.

Conclusions:

• The study found no significant underlying rate of bacterial disc infection in immunocompetent patients with radiculopathy due to disc herniation.
• These results challenge previous findings based on culture methods.
• Further investigation may be needed to understand the etiology of chronic low back pain in these patients.