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Molecular detection of Propionibacterium acnes in biopsy samples of intervertebral disc with modic changes in
Sharif Najafi1, Pedram Mahmoudi1, Seyed Alireza Bassampour2
1Department of Physical Medicine and Rehabilitation, Clinical Biomechanics and Ergonomics Research Center, Aja University of Medical Sciences, Tehran, Iran.
Background And Objectives:
Recent studies have hypothesized that sterile disc infection with the anaerobic Propionibacterium acnes, recently renamed Cutibacterium acnes, occurs in people with intervertebral disc (IVD) herniation. This study aimed to examine the presence of P. acnes in patients who have Low back pain (LBP) with Modic changes observed in their Magnetic Resonance Imaging (MRI).
Materials And Methods:
Thirty-seven patients who were candidates for surgery due to disc herniation and demonstrated Modic changes in MRI were included in the study. Before the surgery, the level of pain in patients was assessed using the visual analog score (VAS). All patients were asked to fill in the Oswestry Low Back Pain Disability Questionnaire. Intervertebral disc changes observed in MRI were recorded for all patients. Then, during surgery, sterile intervertebral disc samples were taken. P. acnes detection was performed using PCR in the laboratory. Data analysis with Chi-squared test, independent samples t-test, and Mann-Whitney U test in SPSS 18.0.
Results:
The mean age of 37 patients equaled 43.64 years and the mean duration of symptoms was 11.05 months. In molecular examination, of the 37 individuals, the genome of P. acnes was positive in 23 cases (62.2%) and negative in 14 (37.8%). The relationship between VAS, disability score, changes in MRI, and patients' age with the positivity of the intervertebral disc sample was also assessed. Of these variables, only age was significantly correlated with the positive molecular finding, such that with an increase in age, the probability of positive findings was increased (p = 0.022).
Conclusion:
Based on the results, lumbar disc infection with P. acnes may play a significant role in causing Modic changes and the progression of the disease in patients with LBP.
Insights
Propionibacterium acnes (P. acnes) infection may be linked to Modic changes in patients with low back pain (LBP). This bacterial presence, detected via PCR in disc samples, correlated with increased age in LBP patients.
Area of Science:
- Spinal pathology
- Microbiology
- Radiology
Background:
- Intervertebral disc (IVD) herniation is increasingly hypothesized to involve sterile disc infection by Propionibacterium acnes (P. acnes), now Cutibacterium acnes.
- Low back pain (LBP) with Modic changes on MRI is a common condition requiring further etiological investigation.
Purpose of the Study:
- To investigate the prevalence of P. acnes in patients with LBP and Modic changes.
- To explore potential correlations between P. acnes presence and clinical/radiological factors.
Main Methods:
- A cohort of 37 surgical candidates with LBP and Modic changes underwent sterile intervertebral disc sampling during surgery.
- P. acnes detection was performed using polymerase chain reaction (PCR).
- Clinical data including visual analog scale (VAS) pain scores, Oswestry Disability Index, and MRI findings were collected.
Main Results:
- P. acnes DNA was detected in 62.2% of the disc samples.
- A significant positive correlation was found between patient age and P. acnes positivity (p = 0.022).
- No significant correlation was observed between P. acnes presence and VAS pain scores, disability scores, or specific MRI changes.
Conclusions:
- Lumbar disc infection with P. acnes may contribute to Modic changes.
- P. acnes infection could be a factor in the pathogenesis and progression of LBP associated with Modic changes.
