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. 2022 Feb;31(2):414-430.
doi: 10.1007/s00586-021-07062-1. Epub 2021 Dec 4.

Evidence for infection in intervertebral disc degeneration: a systematic review

Isabelle Granville Smith  1 , Nathan P Danckert  2 , Maxim B Freidin  3 , Philippa Wells  3 , Julian R Marchesi  2 , Frances M K Williams  3
Affiliations

Evidence for infection in intervertebral disc degeneration: a systematic review

Isabelle Granville Smith et al. Eur Spine J. 2022 Feb.

Abstract

Purpose: Back pain is a major problem worldwide and is linked to intervertebral disc degeneration and Modic change. Several studies report growth of bacteria following extraction of degenerate discs at spine surgery. A pathophysiological role for infection in back pain has been proposed.

Method: We conducted a PRISMA systematic review. MEDLINE, PubMed, Scopus and Web of Science were searched with the terms Modic change, intervertebral dis*, bacteria, microb*, and infect*. Date limits of 2001-2021 were set. Human studies investigating the role of bacteria in disc degeneration or Modic change in vertebrae were included.

Results: Thirty-six articles from 34 research investigations relating to bacteria in human degenerate discs were found. Cutibacterium acnes was identified in pathological disc material. A 'candidate bacterium' approach has been repeatedly adopted which may have biased results to find species a priori, with disc microbial evidence heavily weighted to find C. acnes.

Conclusion: Evidence to date implicates C. acnes identified through culture, microscopy and sequencing, with some suggestion of diverse bacterial colonisation in the disc. This review found studies which used culture methods and conventional PCR for bacterial detection. Further agnostic investigation using newer methods should be undertaken.

Keywords: Bacteria; Degenerate disc; Intervertebral disc; Microbe; Modic change.

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Conflict of interest statement

The authors have no relevant financial or non-financial interest to disclose. The authors have no conflict of interest to declare that are relevant to the content of this article. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interest in any material discussed in this article.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram for evidence for infection in intervertebral disc degeneration: a new systematic review including searches of databases and other sources Adapted from: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. https://doi.org/10.1136/bmj.n71
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