Research and Blog

Degenerate-disc infection study with contaminant control

Prashanth J Rao, Kevin Phan, Rajesh Reddy, Daniel B Scherman, Peter Taylor, and Ralph J Mobbs, Journal of Clinical Neuroscience (2016) 41

Abstract

Study Design

Prospective cohort study.

Objective

To evaluate if degenerative disc–related back orneck pain and/or radicular symptoms are caused by infectionwith low virulent bacterial organisms.

Summary of Background Data

The potential relationship between disc infection and disc degeneration–related symptoms remains controversial, with contradictory evidence available in the literature. Several studies have demonstrated the presence of infected extruded nucleus tissue from first-time disc herniation, implicating the role of disc microbial infection in disc degeneration. The current study is a pilot study evaluating if high infection rates are prevalent in the Australian degenerate disc cohort.

Methods

Institutional ethics approval was obtained (HREC 13/218). The pilot project was a single spine center prospectivecohort of patients undergoing spine surgery for degenerate discdisease. In each case, disc material was obtained and prolongedaerobic and anaerobic cultures performed as per methods usedby Stirlinget al.

Results

To date, a total of 168 patients have been enrolled,with male: female¼1:1. Surgical caseload includes 17.9%anterior cervical fusion, 35.0% anterior lumbar fusion, 40.7%lumbar discectomy, and 5.7% posterior lumbar fusions; 34.1%patients presented with neck pain, 31.6% with arm pain, 59.3%with leg pain, and 64.2% with back pain, and 20.2% of thepatients received transforaminal or epidural or facet jointinjections prior to surgery. In this pilot study, 19.6% wereculture positive, withP. acnespredominant in 50%. Disc-onlycultures were positive in 27.8% of lumbar cases and 18.5% ofcervical cases, with predominant organisms beingP. acnes.

Conclusion

Similar to the infection rates from previousstudies, this Australian cohort had 19.6% infection rates whendisc-only cultures are performed.P. acnesis the predominantorganism followed byStreptococcussp. It is imperative toperform contaminant controls as such high infection with skinbugs is a significant finding.

Keywords

bacterial infection, disc degeneration, prospectivestudy, radiculopathy, sciatica, spine.

Level of Evidence

4

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