Futurum Academy, Länssjukhuset Ryhov, 55185, Jönköping, Sweden.
Sahlgrenska University Hospital, 41346, Göteborg, Sweden.
Eur Spine J. 2019 Dec;28(12):2981-2989. doi: 10.1007/s00586-019-06164-1. Epub 2019 Oct 1.
To compare bacterial findings in pain-generating degenerated discs in adults operated on for lumbar disc herniation (LDH), and mostly also suffering from low back pain (LBP), with findings in adolescent patients with non-degenerated non-pain-generating discs operated on for scoliosis, and to evaluate associations with Modic signs on magnetic resonance imaging (MRI). Cutibacterium acnes (Propionibacterium acnes) has been found in painful degenerated discs, why it has been suggested treating patients with LDH/LBP with antibiotics. As multidrug-resistant bacteria are a worldwide concern, new indications for using antibiotics should be based on solid scientific evidence.
Between 2015 and 2017, 40 adults with LDH/LBP (median age 43, IQR 33-49) and 20 control patients with scoliosis (median age 17, IQR 15-20) underwent surgery at seven Swedish hospitals. Samples were cultured from skin, surgical wound, discs and vertebrae. Genetic relatedness of C. acnes isolates was investigated using single-nucleotide polymorphism analysis. DNA samples collected from discs/vertebrae were analysed using 16S rRNA-based PCR sequencing. MRI findings were assessed for Modic changes.
No bacterial growth was found in 6/40 (15%) LDH patients, compared with 3/20 (15%) scoliosis patients. Most positive samples in both groups were isolated from the skin and then from subcutis or deep within the wound. Of the four disc and vertebral samples from each of the 60 patients, 235/240 (98%) were DNA negative by bacterial PCR. A single species, C. acnes, was found exclusively in the disc/vertebra from one patient in each group. In the LDH group, 29/40 (72%) patients had at least one sample with growth of C. acnes, compared to 14/20 (70%) in the scoliosis group. Bacterial findings and Modic changes were not associated.
Cutibacterium acnes found in discs and vertebrae during surgery for disc herniation in adults with degenerated discs may be caused by contamination, as findings in this group were similar to findings in a control group of young patients with scoliosis and non-degenerated discs. Furthermore, such findings were almost always combined with bacterial findings on the skin and/or in the wound. There was no association between preoperative Modic changes and bacterial findings. Antibiotic treatment of lumbar disc herniation with sciatica and/or low back pain, without signs of clinical discitis/spondylitis, should be seriously questioned. These slides can be retrieved under Electronic Supplementary Material.
比较成年人腰椎间盘突出症（LDH）手术中疼痛产生的退变椎间盘与青少年非退变非疼痛产生的脊柱侧弯手术中椎间盘的细菌发现，并评估与磁共振成像（MRI）上 Modic 征的相关性。痤疮丙酸杆菌（丙酸杆菌属）已在疼痛性退变椎间盘中发现，因此有人建议用抗生素治疗 LDH/LBP 患者。由于多药耐药菌是一个全球性的问题，使用抗生素的新适应症应基于可靠的科学证据。
2015 年至 2017 年，在瑞典的七家医院，40 名患有 LDH/LBP 的成年人（中位年龄 43 岁，IQR 33-49）和 20 名患有脊柱侧弯的对照患者（中位年龄 17 岁，IQR 15-20）接受了手术。从皮肤、手术切口、椎间盘和椎骨采集样本进行培养。采用单核苷酸多态性分析方法研究痤疮丙酸杆菌分离株的遗传相关性。从椎间盘/椎骨采集的 DNA 样本采用基于 16S rRNA 的 PCR 测序进行分析。评估 MRI 结果以确定 Modic 改变。
在 40 名 LDH 患者中，有 6 名（15%）未发现细菌生长，而在 20 名脊柱侧弯患者中，有 3 名（15%）未发现细菌生长。两组中大多数阳性样本均从皮肤分离，然后从皮下或伤口深部分离。在 60 名患者的每个椎间盘和椎体样本中，有 235/240（98%）样本的细菌 PCR 结果为阴性。在每组的一名患者的椎间盘/椎骨中仅发现一种单一的痤疮丙酸杆菌。在 LDH 组中，29/40（72%）患者至少有一个样本中发现了痤疮丙酸杆菌生长，而在脊柱侧弯组中，有 14/20（70%）患者有此发现。细菌发现与 Modic 改变无相关性。
在成年人退变椎间盘的椎间盘突出症手术中，在椎间盘和椎骨中发现的痤疮丙酸杆菌可能是由污染引起的，因为该组的发现与年轻脊柱侧弯和非退变椎间盘患者的对照组相似。此外，这些发现几乎总是与皮肤和/或伤口中的细菌发现相结合。术前 Modic 改变与细菌发现之间无相关性。对于腰椎间盘突出症伴坐骨神经痛和/或腰痛，无临床椎间盘炎/脊椎炎迹象的患者，应慎重考虑使用抗生素治疗。这些幻灯片可以在电子补充材料中检索到。
