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Evidence for infection in intervertebral disc degeneration: a systematic review

Isabelle Granville Smith1, Nathan P Danckert2, Maxim B Freidin3

  • 1Department of Twin Research and Genetic Epidemiology, King's College London, 3rd and 4th Floor, Block D, South Wing, St. Thomas' Hospital, Westminster Bridge Rd., London, SE1 7EH, UK. isabelle.smith@kcl.ac.uk.

European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
|December 4, 2021
PubMed
Abstract

Insights

Back pain is linked to disc degeneration. This review found evidence implicating Cutibacterium acnes (C. acnes) bacteria in degenerate discs, suggesting infection may play a role in back pain.

Area of Science:

  • Spinal Surgery
  • Microbiology
  • Infectious Disease

Background:

  • Back pain is a global health issue, often associated with intervertebral disc degeneration and Modic changes.
  • Bacterial growth has been observed in degenerate discs removed during spinal surgery, proposing an infectious etiology for back pain.

Purpose of the Study:

  • To systematically review the existing literature on the role of bacteria in human intervertebral disc degeneration and Modic changes.
  • To evaluate the evidence for bacterial involvement in the pathophysiology of back pain.

Main Methods:

  • A PRISMA systematic review was conducted.
  • Searches were performed on MEDLINE, PubMed, Scopus, and Web of Science (2001-2021) using terms related to Modic change, intervertebral discs, bacteria, microbes, and infection.
  • Included were human studies investigating bacteria in disc degeneration or Modic change.

Main Results:

  • Thirty-six articles from 34 investigations were identified.
  • Cutibacterium acnes (C. acnes) was frequently identified in pathological disc material.
  • A 'candidate bacterium' approach may have biased findings, with evidence often focused on C. acnes.

Conclusions:

  • Current evidence implicates C. acnes in degenerate discs, detected via culture, microscopy, and sequencing.
  • Some studies suggest diverse bacterial colonization within the disc.
  • Further agnostic research using advanced methods is recommended to explore bacterial involvement comprehensively.
Keywords:
BacteriaDegenerate discIntervertebral discMicrobeModic change

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