Clinical Epidemiology and Ageing

Is the discopathy associated with Modic changes an infectious process? Results from a prospective monocenter study.

Ahmed-Yahia S, Decousser J-W, Flouzat-Lachaniette CHenri, Dervin G, Roubineau F, Audureau E, Hourdille A, Royer G, Eymard F, Chevalier X PLoS One. 2019;14(8):e0221030.

BACKGROUND: The local infectious origin and the putative role of Cutibacterium acnes (CA) of a particular subtype of discopathy (Modic 1) are still debated.

PURPOSE: To establish the association of CA in intervertebral disc (IVD) and Modic 1 discopathy in patients with low back pain.

METHODS: The prevalence of bacteria in IVD samples obtained by anterior approach in patient with chronic low back pain harboring Modic type 1, 2 or no Modic changes was compared to that measured in IVD samples obtained by posterior approach for sciatica. From 45 patients included in the study, 77 discs samples were obtained: 58 by anterior approach (32 Modic 1/2 changes, 26 without Modic change) and 19 by posterior approach. Conventional microbial cultures, universal 16S rRNA molecular detection and a CA specific PCR were performed.

RESULTS: 12 /77 (15.6%) disc samples were culture positive. Among the 10 CA positive cultures, 5 out of 58 (8.6%) were identified from specimens obtained by anterior approach and 5/19 (26.3%) from posterior approach (p = 0.046). Moreover, the percentage of CA culture positive sample was statistically no different between the patient with or without Modic changes. The CA prevalence was lower through molecular, culture-free approaches: the universal 16S rRNA PCR was positive for 6 specimens, including one CA positive sample and the CA specific PCR was positive for one specimen obtained by posterior approach.

CONCLUSIONS: In spine surgery the prevalence of CA in culture was significantly higher in IVD samples collected through a posterior approach compared to an anterior approach, suggesting a contamination process. This study did not support the CA related local infectious origin of Modic 1 discopathy.

MeSH terms: Adult; Female; Gram-Positive Bacterial Infections; Humans; Intervertebral Disc; Intervertebral Disc Degeneration; Low Back Pain; Male; Middle Aged; Prevalence; Propionibacterium acnes; Prospective Studies
DOI: 10.1371/journal.pone.0221030