{Reference Type}: Journal Article
{Title}: Bacterial identification in herniated intervertebral discs: a prospective cohort study.
{Author}: Astur N;Martins DE;Kanas M;Doi AM;Martino MDV;Filho ENK;Wajchenberg M;Lenza M;
{Journal}: Spine J
{Volume}: 0
{Issue}: 0
{Year}: 2024 Jun 4
{Factor}: 4.297
{DOI}: 10.1016/j.spinee.2024.05.015
{Abstract}: <B>BACKGROUND: </B>Reports of Cutibacterium acnes isolated in cultures of intervertebral disc samples suggest it as possibly responsible for inflammatory conditions causing Modic changes on spinal magnetic resonance imaging (MRI).<BR><B>OBJECTIVE: </B>Our objective was to investigate the prevalence of C. acnes in samples of intervertebral disc of patients with lumbar disc herniation; to investigate prognostic factors and the relationship of Modic changes with infection 1 year after microdiscectomy.<BR><B>METHODS: </B>Prospective cohort study.<BR><B>METHODS: </B>In this single-center study, patients consecutively operated on for disc herniation had samples of the disc, multifidus muscle and ligamentum flavum (as an indication of contamination) extracted for culture.<BR><B>METHODS: </B>Age, sex, alcohol and tobacco consumption, body mass index; function, pain, and Modic chances in MRI before surgery and MRI 1 year later; rate of disc, muscle and ligament infection (primary outcome); diabetes and corticoid use (confoundings).<BR><B>METHODS: </B>The protruded disc, muscle and ligament samples were sent for culture analysis in up to 30 minutes. A subsample of 17 patients underwent next-generation sequencing (NGS) molecular analysis too. We performed descriptive analysis and comparison of groups of patients with and without infection or contamination using Student's t, Mann-Whitney, chi-square, or Fisher's exact tests as appropriate, and pre- and postsurgical comparisons with the Wilcoxon test.<BR><B>RESULTS: </B>From January 2018 to September 2019, 112 patients underwent open lumbar microdiscectomy, 67 (59.8%) men. Cultures showed 7 (6.3%) positive cases in the disc (2 with C. acnes), 3 (2.7%) in the ligament, and 12 (10, 7%) in muscle. No evidence of a difference in Modic alterations pre- or postoperatively was found between patients with and without positive culture 1 year after surgery. No association was found between culture positivity and functional or pain differences either. NGS results were all negative for C. acnes.<BR><B>CONCLUSIONS: </B>We identified infective bacterial presence in the herniated disc in less than 2% of patients with disc herniation. C. acnes was not identified in any disc microbiome analysis. No significant association was observed between positivity for tissue infection and any clinical prognostic factor.