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Bacteriology of Degenerated Lumbar Intervertebral Discs.
MedLine Citation:
PMID:  22832554     Owner:  NLM     Status:  Publisher    
STUDY DESIGN:: A prospective microbiological analysis of intervertebral disc material in surgically treated patients presenting lumbar disc degeneration. OBJECTIVE:: To determine the prevalence and species of bacteria in degenerated lumbar discs, their eventual role in the pathophysiology, and the possible influence of risk factors. SUMMARY OF BACKGROUND DATA:: Intervertebral disc degeneration results from biochemical, mechanical, genetic and toxic factors. The hypothesis of low-grade infection has been raised but not elucidated to date. METHODS:: Eighty-three patients (34 males, 49 females, 41 years) were treated by lumbar disc replacement at L3-L4, L4-L5 or L5-S1. An intraoperative biopsy and microbiological culture were performed for each disc to determine if intradiscal bacteria were present. Magnetic resonance stages were Pfirrmann IV or V, with Modic I in 32 and Modic II in 25 cases. A preoperative discography was performed in 49 patients, 24 had previous nucleotomy. RESULTS:: Bacteria were found in 40 discs, 43 cultures were sterile. The following bacteria were evidenced: Propionibacterium acnes 18, coagulase-negative Staphylococci 16, gram-negative Bacilli 3, Micrococcus 3, Corynebacterium 3, others 5. Ten biopsies presented two different species. Multinucleated cells were evidenced histologically in 33% of positive biopsies. Bacteria were predominantly found in males (P=0.012). The mostly positive level was L4-L5 (P=0.075). There was no significant relationship between bacterial evidence and Modic sign. A preoperative discography or previous nucleotomy did not represent significant contamination sources. None of the patients presented infectious symptoms. CONCLUSIONS:: Although the hypothesis of biopsy contamination cannot be excluded, intradiscal bacteria might play a role in the pathophysiology of disc degeneration. However, the histological presence of multinucleated cells may indicate an inflammatory process that could sustain the hypothesis of low-grade spondylodiscitis at one stage of the cascade of lumbar disc degeneration. These microbiological and histological findings would need to be compared to non degenerated discs. LEVEL OF EVIDENCE:: Diagnostic level III.
Joseph Arndt; Yann Philippe Charles; Christelle Koebel; Ioan Bogorin; Jean-Paul Steib
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-7-24
Journal Detail:
Title:  Journal of spinal disorders & techniques     Volume:  -     ISSN:  1539-2465     ISO Abbreviation:  -     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-7-26     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101140323     Medline TA:  J Spinal Disord Tech     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
*Departments of Spine Surgery †Microbiology, University Hospital of Strasbourg, France.
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