Rao Prashanth J, Phan Kevin, Reddy Rajesh, Scherman Daniel B, Taylor Peter, Mobbs Ralph J
Prince of Wales Private Hospital, Randwick, Sydney, Australia.
University of New South Wales (UNSW), Sydney, Australia.
Spine (Phila Pa 1976). 2016 Jun;41(11):935-939. doi: 10.1097/BRS.0000000000001404.
Prospective cohort study.
To evaluate if degenerative disc-related back or neck pain and/or radicular symptoms are caused by infection with low virulent bacterial organisms.
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.
Institutional ethics approval was obtained (HREC 13/218). The pilot project was a single spine center prospective cohort of patients undergoing spine surgery for degenerate disc disease. In each case, disc material was obtained and prolonged aerobic and anaerobic cultures performed as per methods used by Stirling et al.
To date, a total of 168 patients have been enrolled, with male: female = 1:1. 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 the patients received transforaminal or epidural or facet joint injections prior to surgery. In this pilot study, 19.6% were culture positive, with P. acnes predominant in 50%. Disc-only cultures were positive in 27.8% of lumbar cases and 18.5% of cervical cases, with predominant organisms being P. acnes.
Similar to the infection rates from previous studies, this Australian cohort had 19.6% infection rates when disc-only cultures are performed. P. acnes is the predominant organism followed by Streptococcus sp. It is imperative to perform contaminant controls as such high infection with skin bugs is a significant finding.
前瞻性队列研究。
评估退行性椎间盘相关的腰背痛或颈痛和/或神经根症状是否由低毒力细菌感染引起。
椎间盘感染与椎间盘退变相关症状之间的潜在关系仍存在争议，文献中有相互矛盾的证据。几项研究已证明首次椎间盘突出症患者的脱出髓核组织存在感染，这暗示了椎间盘微生物感染在椎间盘退变中的作用。本研究是一项初步研究，旨在评估澳大利亚退行性椎间盘队列中是否普遍存在高感染率。
获得了机构伦理批准（HREC 13/218）。该试点项目是一个单一脊柱中心对因退行性椎间盘疾病接受脊柱手术的患者进行的前瞻性队列研究。在每个病例中，获取椎间盘组织，并按照斯特林等人使用的方法进行延长的需氧和厌氧培养。
迄今为止，共纳入168例患者，男女比例为1:1。手术病例包括17.9%的颈椎前路融合术、35.0%的腰椎前路融合术、40.7%的腰椎间盘切除术和5.7%的腰椎后路融合术；34.1%的患者有颈痛，31.6%有臂痛，59.3%有腿痛，64.2%有背痛，20.2%的患者在手术前接受了经椎间孔或硬膜外或小关节注射。在这项初步研究中，19.6%的培养结果为阳性，痤疮丙酸杆菌占50%。仅椎间盘培养在27.8%的腰椎病例和18.5%的颈椎病例中呈阳性，主要病原体为痤疮丙酸杆菌。
与先前研究的感染率相似，该澳大利亚队列在仅进行椎间盘培养时感染率为19.6%。痤疮丙酸杆菌是主要病原体，其次是链球菌属。由于皮肤细菌的如此高感染率是一个重要发现，因此必须进行污染物对照。
4级。
