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Updated: Jul 2, 2025
A Proinflammatory, Degenerative Organ Culture Model to Simulate Early-Stage Intervertebral Disc Disease.
Published on: February 14, 2021
Risk factors associated with low-grade virulent infection in intervertebral disc degeneration: a systematic review
Mingtao Zhang1, Jingwen Jia1, Liangna Deng2
1Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou 730000, Gansu, China; Orthopaedics Key Laboratory of Gansu Province, No. 82 Cuiyingmen, Chengguan District, Lanzhou, Gansu, 730000, China.
Background:
An increasing number of research indicates an association between low-grade bacterial infections, particularly those caused by Propionibacterium acnes (P. acnes), and the development of intervertebral disc degeneration (IDD). However, no previous meta-analysis has systematically assessed the risk factors for low-grade bacterial infections that cause IDD.
Purpose:
This study reviewed the literature to evaluate the risk factors associated with low-grade bacterial infection in patients with IDD.
Study Design:
Systematic review and meta-analysis.
Methods:
The systematic literature review was conducted using the PubMed, Web of Science, Embase, and Cochrane Library databases. Eligible articles explicitly identified the risk factors for low-grade bacterial infections in IDD patients. Patient demographics and total bacterial infection rates were extracted from each study. Meta-analysis was performed using random- or fixed-effects models, with statistical analyses conducted using Review Manager (RevMan) 5.4 software.aut.
Results:
Thirty-three studies involving 4,109 patients were included in the meta-analysis. The overall pooled low-grade bacterial infection rate was 30% (range, 24%-37%), with P. acnes accounting for 25% (range, 19%-31%). P. acnes constituted 66.7% of bacteria-positive discs. Fourteen risk factors were identified, of which 8 were quantitatively explored. Strong evidence supported male sex (odds ratio [OR] = 2.15; 95% confidence interval [CI]=1.65-2.79; p<.00001) and Modic changes (MCs) (OR=3.59; 95% CI=1.68-7.76; p=.0009); moderate evidence of sciatica (OR=2.31; 95% CI=1.33-4.00; p=.003) and younger age (OR=-3.47; 95% CI=-6.42 to -0.53; p=.02). No evidence supported previous disc surgery, MC type, Pfirrmann grade, smoking, or diabetes being risk factors for low-grade bacterial infections in patients with IDD.
Conclusions:
Current evidence highlights a significant association between IDD and low-grade bacterial infections, predominantly P. acnes being the most common causative agent. Risk factors associated with low-grade bacterial infections in IDD include male sex, MCs, sciatica, and younger age.
Insights
Low-grade bacterial infections, especially Propionibacterium acnes (P. acnes), are linked to intervertebral disc degeneration (IDD). Key risk factors include male sex, Modic changes, sciatica, and younger age.
Area of Science:
- Orthopedics
- Infectious Disease
- Spinal Surgery
Background:
- Emerging research links low-grade bacterial infections, particularly Propionibacterium acnes (P. acnes), to intervertebral disc degeneration (IDD).
- Previous meta-analyses have not systematically evaluated risk factors for these infections in IDD.
- This study addresses this gap by reviewing and analyzing the literature.
Purpose of the Study:
- To systematically review and evaluate the risk factors associated with low-grade bacterial infections in patients diagnosed with IDD.
- To synthesize existing evidence on the prevalence and specific risk factors contributing to bacterial infections in IDD.
Main Methods:
- A systematic literature review was performed using major databases (PubMed, Web of Science, Embase, Cochrane Library).
- Eligible studies identifying risk factors for low-grade bacterial infections in IDD patients were included.
- Meta-analysis was conducted using random- or fixed-effects models to pool data from 33 studies involving 4,109 patients.
Main Results:
- The pooled prevalence of low-grade bacterial infection in IDD was 30%, with P. acnes being the most common agent (25%).
- Strong evidence identified male sex (OR=2.15) and Modic changes (MCs) (OR=3.59) as significant risk factors.
- Moderate evidence supported sciatica (OR=2.31) and younger age (OR=-3.47) as risk factors.
Conclusions:
- A significant association exists between intervertebral disc degeneration (IDD) and low-grade bacterial infections, primarily caused by P. acnes.
- Identified risk factors for these infections in IDD patients include male sex, Modic changes, sciatica, and younger age.
- Further research may elucidate more nuanced relationships and refine clinical management strategies.
